NURS 485 Exam 1

Which of the following statements about trends and issues influencing health care economics and community health services delivery are true? Select all that apply. A) The United States has the most cost effective health care system in the world. B) One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. C) In the United States, the health-related quality of life is lower than for most other countries. D) The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. E) In a survey published in 2009, most US physicians identified that their health care system worked well.

-One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. -In the United States, the health-related quality of life is lower than for most other countries. -The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. Rationale: The United States has one of the least cost effective health care systems in the world. One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. In the United States, the health-related quality of life is lower than for most other countries. The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. In a survey published in 2009, most US physicians did not identify that their health care system worked well.

How can nursing fulfill the potential to transform nursing and take the power to influence policy development? Select all that apply. A) Practicing to the full extent of their education and training B) Achieving higher levels of education and training through an improved education system that promotes seamless academic progression C) Act as full partners, with physicians and other health professionals, in redesigning health care in the United States D) Improve data collection and an improved information infrastructure to ultimately influence effective workplace planning and policy making E) Most nurses are already involved in the regulatory framework development.

-Practicing to the full extent of their education and training -Achieving higher levels of education and training through an improved education system that promotes seamless academic progression -Act as full partners, with physicians and other health professionals, in redesigning health care in the United States -Improve data collection and an improved information infrastructure to ultimately influence effective workplace planning and policy making Rationale: The four key messages from The Future of Nursing: Leading Change, Advancing Health include the following: 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure. It is not yet true that most nurses are already involved in the regulatory framework development.

Organize the following stages in the policy process in the order they should be considered. A) Policy Adoption (2) B) Policy Evaluation (4) C) Policy Formulation (1) D) Policy Implementation (3)

Answer: -Policy Formulation -Policy Adoption -Policy Implementation -Policy Evaluation Rationale: The order of the stages in the policy process is formulation, adoption, implementation, and evaluation.

After a class on nursing and political activism, which statement by the nursing student would indicate that the teaching was successful? A) "Nurses have just now become increasingly active in the political arena." B) "Nurses are the smallest group of providers with the largest voice." C) "Nurses are considered major political players in Washington." D) "The ANA provides nurses with a collective political voice."

Answer: " The ANA provides nurses with a collective political voice." Rationale: A professional nursing association such as the ANA builds a collective voice for nurses. Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be realized. Nursing also is not thought of as a major player in Washington when discussing health care policy.

After a class on important historical influences on community health care, the students are asked to describe the impact of the Shattuck Report. Which response indicates that the students have understood the information? A) "It influenced the speed with which health-focused bills pass the legislature." B) "The report set up the organizational structure of the U.S. Public Health Service." C) "It emphasized sanitary progress forming the basis for current public health practice." D) "It de-emphasized the issues addressed in the Hebrew hygienic code."

Answer: "It emphasized sanitary progress forming the basis for current public health practice." Rationale: The Shattuck Report, a landmark document, made a tremendous impact on sanitary progress addressing public health concepts and methods that form the basis of public health practice today. It had no effect on getting bills passed by the legislation nor was it involved in setting up the organizational structure of the U.S. Public Health Service. The Hebrew hygienic code, probably the first written code, was the prototype for personal and community sanitation.

A community health nurse working at the local level is attending an in-service program about health care economics. The nurse asks the presenter, "Why do I need to know this information? My focus is my clients." Which response by the presenter would be most appropriate? A) "You are required to know this information because your agency receives government funding." B) "You might be in management one day and have to deal with cost control and reimbursement." C) "Although it seems foreign to you, it's an important topic that you might have to deal with someday." D) "This knowledge is important to the success of your practice and for the agency's survival."

Answer: "This knowledge is important to the success of your practice and for the agency's survival." Rationale: At the local level (the community health nurse and the employing agency), health care economics is very important for survival. Resourceful use of time, talent, and materials will ensure that the services will be able to continue and that the agency stays viable. Government funding, a future role in management, and dealing with the issue in the future are inappropriate and do not emphasize the importance of the effect of health care economics.

When analyzing health policy, which question would be most important for the community health nurse to ask? A) "How much does it cost?" B) "What is the result?" C) "Why is it in place?" D) "Who benefits from it?"

Answer: "Who benefits from it?" Rationale: When analyzing policy, nurses need to answer two general questions: Who benefits from this policy? and who loses from this policy? Whether the policy should be advocated by the community as a whole depends on the degree to which the policy benefits the community without being detrimental to individuals or the country. Cost, results, and reasons why are not key elements to address in policy analysis.

Which of the following statements about professional organizations and public policy is the most accurate? A) Professional organizations increase polarization and cause a group to be more united and strong. B) Professional organizations encourage selfishness and self-interest. C) Professional organizations focus solely on "protecting their turf." D) A united voice on public policy is more powerful than individuals pleading with legislators.

Answer: A united voice on public policy is more powerful than individuals pleading with legislators. Rationale: A united voice on public policy is more powerful than individuals pleading with legislators. The other statements about professional organizations are not true. They do not increase polarization and if they did, it would not cause the group to be more united and strong. Professional organizations do not increase selfishness and self-interest, and professional nursing organizations do not focus solely on "protecting their turf."

Which is the best way for any nurse to advocate for change and exert power? A) Pursuing an advanced degree B) Running for state congressional seat C) Actively participating in a professional nursing organization D) Becoming a member of a local not-for-profit agency board of directors

Answer: Actively participating in a professional nursing organization Rationale: A major way in which nurses have been successful with advocacy is through membership in their professional organization. Influencing policy may be achieved by obtaining advanced education, which would be helpful in pursuing higher level positions, and political office whether at the local or state level. Influencing policy is not the same as advocating.

After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor? A) Homelessness B) Acute illness C) Income D) Immigrant status

Answer: Acute illness Rationale: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.

When discussing the economics of health care with colleagues, the community health nurse addresses macroeconomic theory. Which of the following would the nurse include? A) Quantity of services available B) Consumer's willingness to buy services C) Aggregate perspective of economic stability D) Allocation of the available resources

Answer: Aggregate perspective of economic stability Rationale: Macroeconomic theory is concerned with the broad variables that affect the status of the economy as a whole, such as factors affecting aggregate consumptions, production, investment, and international trade. The focus is on the larger view of economic stability and growth, providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of services available) and demand (consumer's willingness to buy services) and study how allocation and distribution affect consumer demand for goods and services.

When working with immigrant groups in community health care, which of the following would be least appropriate for the community health nurse to do? A) Permit ample time for interviewing to allow time to evaluate beliefs B) Develop educational programs to correct misconceptions C) Assume that the client has a basic understanding of health issues D) Ensure an appropriate interpreter for communication if needed

Answer: Assume that the client has a basic understanding of health issues Rationale: When working with immigrant groups in the community, do not make assumptions about a client's understanding of health care issues; permit more time for interviewing; allow time to evaluate beliefs and provide appropriate interventions; provide educational programs to correct any misconceptions about health issues; provide an appropriate interpreter to improve communication with immigrants who do not speak English well.

A community health nurse is engaged in provision of care to clients in a clinic setting at the local health department. This nurse is engaging in which core public health function? A) Clinical B) Assessment C) Policy development D) Assurance

Answer: Assurance Rationale: The three core public health functions are assessment, policy development, and assurance. Assessment would involve assessing the community, policy development would involve helping to establish policies that will address the problems assessed, and assurance would involve making sure that the services indicated by policies (following assessment) are available to the community. Clinical is not a core public health function.

A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion? A) Avoiding political involvement in issues B) Working with schools to reduce the dropout rate C) Organizing task forces to raise community awareness D) Holding community meetings to identify needs

Answer: Avoiding political involvement in issues Rationale: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.

When working with different cultural groups in the area of health care practices, the nurse acts as an effective advocate for the client. Which of the following must the nurse do first? A) Prepare to teach clients about the limits and benefits of cultural health practices B) Assess the client or family adequately to ascertain their belief system and choices C) Individualize caregiving for the client within his or her culture D) Be knowledgeable about health care practices and choices

Answer: Be knowledgeable about health care practices and choices Rationale: When working with different cultural groups in the area of health care practices, the community health nurse can be an effective advocate for the client. First, however, the nurse must be prepared to speak knowledgeably about health care practices and choices. The nurse also must be able to assess the client or family adequately so as to know what belief system motivates their choices. Finally, the nurse must be prepared to teach clients about the limits and benefits of cultural health care practices. The community health nurse should always individualize assessment and caregiving for the client within his or her culture and should not generalize about the client based on cultural group norms.

17. What is the most important reason for the nurse to conduct a cultural assessment? A) Because it is often assigned by nursing faculty B) Because usually there is some culturally based reason that causes clients to engage in or avoid certain actions C) To meet the nurse's professional learning needs D) Because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action

Answer: Because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action Rationale: The most important reason for the nurse to conduct a cultural assessment is that because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action. There is usually some culturally based reason that causes clients to engage in or avoid certain actions but that is not the most important reason for the nurse to conduct a cultural assessment. The nurse does not necessarily collect a cultural assessment to meet his or her own needs primarily.

A community health nurse is developing health promotion programs for a local community that consists predominantly of African Americans. Which of the following areas would be a priority for health promotion with this group? A) Cardiac health B) Respiratory care C) Mental health D) Skin care

Answer: Cardiac health Rationale: Leading causes of death for African Americans include heart disease, cancer, and stroke. Heart disease is also a major health problem. Thus programs emphasizing cardiac health would be a priority. African Americans show a lower incidence in suicide and chronic obstructive pulmonary disease. They may experience skin problems such as keloids and melasma. However, all of these conditions would be of lesser importance than cardiac health.

Which of the following would a community health nurse include when describing the differential vulnerability hypothesis? A) Exposure to risk factors affects the population's social and human capital. B) Everyone is at risk because of stressful events occurring in life. C) A risk for a negative outcome increases with lower education and income levels. D) Certain groups are impacted by stressful events more than others.

Answer: Certain groups are impacted by stressful events more than others. Rationale: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.

When engaging in the policy process, which of the following would the community health nurse do last? A) Define the problem B) Gather information C) Look for alternatives D) Choose the approach

Answer: Choose the approach Rationale: Policy analysis involves the following sequential steps: define the problem, information gathering, looking for alternatives to the approach, and choose the most appropriate approach.

A community health nurse is working to empower clients of a vulnerable population. Which of the following client behaviors indicates that the nurse is achieving this goal? A) Collaboration with their health care providers B) Demonstration of a reactive focus C) Hesitancy in the use of resources D) Viewing of situations as non-changeable

Answer: Collaboration with their health care providers Rationale: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.

Which one of the following groups of actions fulfills the three core public health functions in their proper order? A) Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school B) Identifying a source of pollution in the community, educating local residents about precautions that should be taken when the pollution exceeds minimum standards, and asking legislators to apply sanctions to the responsible party for the source of pollution C) Providing prenatal care for pregnant adolescents, determining how many pregnant adolescents currently attend the school, and encouraging school officials to provide an alternative school setting for the pregnant adolescents D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services in the community, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer

Answer: Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school Rationale: The three core public health functions are assessment, policy development, and assurance. Assessment is data collection, the policy development would be based on the assessment, and assuring is the process of translating established policies into services. Counting the number of kindergarten students who are fully immunized would be assessment, encouraging the school officials to exclude children who are not fully immunized would be policy development, and offering immunization clinics at the school would be assurance. Identifying a source of pollution in the community would be assessment, educating local residents about precautions that should be taken when the pollution exceeds minimum standards would be assurance, and asking legislators to apply sanctions to the responsible party for the source of pollution would be policy development. Providing prenatal care for pregnant adolescents would be assurance, determining how many pregnant adolescents currently attend the school would be assessment, and encouraging school officials to provide an alternative school setting for pregnant adolescents would be assurance. Lobbying for a citywide ban on smoking in public would be policy development, providing smoking cessation services in the community would be assurance, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer would be assessment.

Which of the following effects of a health system in disarray have the most direct influence for a public health nurse at this present time? A) The United States is often touted as having the best health care system in the world. B) Fewer jobs for nurses C) Crisis in public health related to underfunding and underappreciation of the core functions of public health leading to substantial reduction in public health programs D) Changes in the Medicare payment system

Answer: Crisis in public health related to underfunding and underappreciation of the core functions of public health leading to substantial reduction in public health programs Rationale: Currently, there is serious underfunding and underappreciation of the core functions of public health, which has led to massive layoffs of staff and substantial reduction in public health programs. The United States is often touted as having the best health care system in the world. However, this may be in question related to the expense of our current health problems and the lack of benefit to the health of all Americans. There is currently a serious nursing shortage that is projected to only get worse in the coming decades. There are changes in the Medicare payment system and this does affect health care in general but most public health programs do not receive Medicare support.

The community health nurse is reviewing how managed care today has changed from its initial proposal. Which of the following would the nurse identify as an important change? A) Current emphasis on cost containment B) Focus on choosing a practitioner C) Expansion in types of care provided D) Increase in nonprofit agencies

Answer: Current emphasis on cost containment Rationale: Managed care has evolved and the emphasis has shifted from prevention to cost containment. Reductions in reimbursement particularly for disadvantaged patients (e.g., those covered under Medicaid and Medicare), reductions in the choice of practitioners, and limitations on the types of care available transformed this system as originally envisioned. Most managed care today is for profit, setting up a dichotomy between the insured and the owners/investors.

When applying the principles of transcultural nursing, which of the following must the nurse do first? A) Cultivate cultural sensitivity B) Develop cultural awareness C) Learn the client's group culture D) Demonstrate respect for culture

Answer: Develop cultural awareness Rationale: Applying the principles of transcultural nursing involves the following: (1) developing cultural self-awareness, (2) cultivating cultural sensitivity, (3) assessing the client group's culture, (4) showing respect and patience while learning about other cultures, and (5) examining culturally derived health practices.

A community health nurse is evaluating a population for socioeconomic resources. Which of the following would the nurse address? A) Quality of care provided B) Access to health care services C) Educational opportunities D) Adequacy of health care providers

Answer: Educational opportunities Rationale: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.

Which of the following is an example of a distributive health policy? A) Reporting of communicable disease B) Federal funds for nursing education C) Medicare D) Arms control agreement

Answer: Federal funds for nursing education Rationale: Distributive health policy promotes nongovernmental activities that are thought to be beneficial to society as a whole. An example of a distributive policy is the Nurse Training Act, Title VIII of the Public Health Service Act, which was established in 1965 and provided federal subsidies for nursing education in an effort to address the need for a more nurses. Reporting of communicable diseases and arms control agreement are examples of regulatory health policy at the national and international levels respectively. Medicare is an example of a redistributive health policy.

A community health nurse is providing care to several cultural groups in the community. When providing transcultural nursing, which of the following would be the priority? A) Examining one's own culture carefully and recognizing that alternative viewpoints are possible B) Recognizing that cultural values, beliefs, and practices influence people's health and lifestyles C) Obtaining health-related information about a cultural group concerning their values, beliefs, and practices D) Actively and attentively listening to demonstrate respect while learning about other cultures

Answer: Examining one's own culture carefully and recognizing that alternative viewpoints are possible Rationale: The first step in providing transcultural nursing is to develop cultural self-awareness by examining one's own culture carefully and recognizing that alternative viewpoints are possible. Next, the nurse would need to cultivate cultural sensitivity by recognizing that cultural values, beliefs, and practices influence people's health and lifestyle. Then the nurse would assess the client group's culture by obtaining health-related information and actively and attentively listening to demonstrate respect.

When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk? A) Well-balanced diet B) Up-to-date immunizations C) Enabling factors D) Exposure to abuse

Answer: Exposure to abuse Rationale: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable Populations and not to the relative risk.

When involved in the policy process, the community health nurse must keep in mind which of the following should be the strongest influence? A) Social conditions B) Political conditions C) Public need D) Health planning

Answer: Public need Rationale: The social and political conditions that affect policy formulation are limitless, but public need and public demand should be the strongest influences. Health planning may be an approach to policy formulation.

A community health nurse is assessing a family during a home visit. The nurse is examining the mother who is pregnant with her second child. The nurse asks the mother to raise her arms above her head. The mother replies, "I can't do this because it will cause the umbilical cord to strangle the baby." The nurse interprets this statement as reflective of which of the following? A) Home remedy B) Herbalism C) Folk medicine D) Alternative therapy

Answer: Folk medicine Rationale: The mother's statement reflects folk medicine, a body of preserved treatment practices that has been handed down verbally from generation to generation. One example is not reaching above your head if you are pregnant, because doing so will cause the umbilical cord to strangle the baby. Home remedies are caregiving practices passed down between families, for example, ice on a cold sore, baking soda paste on a bee sting. Herbalism involves the use of medicinal herbs. Alternative therapy or complementary therapy is designed to promote comfort, health, and well-being and includes, for example, aromatherapy, music therapy, acupuncture, and yoga.

A community health nurse identifies a problem of increased infant mortality with adolescent pregnancies. The nurse decides to address this problem with a health policy. The nurse is engaging in which stage of the policy process? A) Formulation B) Adoption C) Implementation D) Evaluation

Answer: Formulation Rationale: Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Implementation follows adoption and occurs when the policy is put to use. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.

A community health nurse is providing care to an Asian American family who believes that a member's current illness is due to an excess of yin. The nurse integrates knowledge of this belief, expecting the family to avoid which foods? A) Rice B) Eggs C) Chicken D) Fruits

Answer: Fruits Rationale: If the imbalance is an excess of yin, then "cold" foods, such as vegetables and fruits, are avoided, and "hot" foods, such as rice, chicken, eggs, and pork, are offered.

Which of the following would be most important for a community health nurse to do first when working with vulnerable populations? A) Helping them to make choices B) Guiding them to think things through C) Getting them to interact with the nurse D) Providing honest feedback

Answer: Getting them to interact with the nurse Rationale: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.

A group of community health nurses are discussing health care policy in the United States. Which of the following reflects the consensus view? A) Market forces should solve the problem. B) The government should assume responsibility. C) Health care policy needs to change. D) Health care policy is flawed but adequate.

Answer: Health care policy needs to change Rationale: Most people agree that health care policy in the United States must change, but there is little agreement among policy makers and citizens about how this should occur. Some believe market forces should be allowed to work this problem out; others believe the government should assume responsibility. Health care policy is not viewed as being adequate.

A community health nurse is involved in assessing the community's capacity to define strategies to enhance compliance with a policy. The nurse is working in which stage of the policy process? A) Formulation B) Adoption C) Implementation D) Evaluation

Answer: Implementation Rationale: Implementation of health policy occurs when an individual, group, or community puts the policy into use. It involves overt behavior changes as the policy is put into nursing practice. As an implementer, the community health nurse assesses the capacity of the community to formulate and define strategies that will enhance the community's compliance with the policy. Health policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy evaluation means comparing policy outcomes or effects with the intended or desired effects.

The community health nurse is working in the health department of a major city that has a large Hispanic/Latino population. Which of the following would the nurse need to integrate into the plan of care for this population? A) View of the female as superior to the male B) Importance of an extended, cohesive family C) Males as the binding force of the family D) Adherence to strict time schedules

Answer: Importance of an extended, cohesive family Rationale: Hispanic people value extended, cohesive families. Families have been patriarchal, with male members perceived as superior and female members seen as a family-bonding life force. Many Latinos tend to be oriented to the present and are not as concerned as the mainstream culture about keeping time schedules or preparing for the future.

A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor? A) Insurance B) Acculturation C) Knowledge of disease D) Marital status

Answer: Insurance Rationale: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources). Acculturation, knowledge of disease, and marital status are examples of predisposing factors.

A community health nurse implements a plan of care that combines aromatherapy and acupuncture with medication therapy and surgery. The nurse is applying which of the following? A) Holistic health care B) Folk medicine care C) Herbalistic health care D) Integrated health care

Answer: Integrated health care Rationale: Integrated health care is defined as the combination of complementary therapies such as aromatherapy and acupuncture with biomedical or Western health care such as medication therapy and surgery. Holistic health care vies the world as being in harmonious balance in which all facets of the individual's natures (physical, mental, emotional, and spiritual) must be in balance. Folk medicine involves treatment practices that have been handed down from generation to generation. Herbalism is the use of medicinal herbs.

When developing an in-service program for a group of community health nurses about culture, which of the following would the presenter expect to include? A) All members of a cultural group are alike. B) Intraethnic variations underscore a population's cultural diversity. C) Ethnicity has a major impact on the effectiveness of health care. D) Ethnocentric attitudes are key to working with different cultures.

Answer: Intraethnic variations underscore a population's cultural diversity Rationale: Intraethnic variations, differences within microcultures, underscore the range of culturally diverse clients served by community health nurses. Subcultures and microcultures have their own distinctive characteristics even within fairly homogenous cultural groups. Culture, not ethnicity, has a major impact on the effectiveness of health care. Ethnocentric attitudes are to be avoided. All members of a cultural group are not alike. In general, individuals who are members of a specific culture are more alike than unlike but still not totally alike.

After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and health is which of the following? A) Direct B) Inverse C) Positive D) Unequal

Answer: Inverse Rationale: The socioeconomic gradient refers to the inverse relationship between social class or income and health, such that the lower the social class or income, the higher the rates of disease.

Which of the following statements about Health Care Rationing is most accurate? A) It will not occur in the United States because of our country's values. B) A danger of rationing is compromising quality and effectiveness. C) Rationing in health care has never been practiced. D) Advances in knowledge and technological capabilities will eliminate the need for rationing in the future.

Answer: It will not occur in the United States because of our country's values Rationale: A danger of rationing is compromising quality and effectiveness. Rationing is already practiced in this country to some extent and for many years. Advances in knowledge and technological capabilities compound rationing decisions.

When developing a teaching plan for a class that describes health policy, which of the following would the instructor include as an example of a regulatory health policy? A) Licensure of health professionals B) Federal subsidies for nursing education C) Benefits for needy groups D) Allocating resources among groups

Answer: Licensure of health professionals Rationale: Regulatory health policy regulates or licenses services or people providing services in the community. Distributive health policy subsidizes nursing education, benefits the needy, and allocates resources among and between groups.

When assessing a population's vulnerability, which of the following would the community health nurse identify as a predisposing factor? A) Social support networks B) Crime rates C) Transportation D) Living conditions

Answer: Living conditions Rationale: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).

When describing the causes of vulnerability to a group of students, which of the following would the instructor include? A) Vulnerable populations are fairly similar across the nation and globally. B) Statistics about vulnerable populations are highly accurate. C) The most important causative factor is race or ethnicity. D) Many of the factors and conditions suggest vulnerability overlap. Ans: D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.

Answer: Many of the factors and conditions suggest vulnerability overlap Rationale: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.

After teaching a community group about the Medicaid program, which of the following would indicate to the nurse that additional teaching is necessary? A) Medicaid has a monthly fee that recipients must pay. B) Medicaid is administered individually by each state. C) Medicaid focuses on preventative services. D) It is possible to be on both Medicare and Medicaid.

Answer: Medicaid has a monthly fee that recipients must pay Rationale: Medicaid monies come to the states from the federal government. Each state determines who will receive what kinds of health care services. This makes it a uniquely different program in each state. Medicaid is a free program available to individuals on the basis of financial need and legal residency status. Medicaid has a major focus on preventative services, namely, infant, childhood, and elder immunization programs. Eligibility is determined on the basis of financial need and residency status. Finally, some low-income Medicare eligible people also receive Medicaid.

A community health nurse is providing care to a family in the community who are Muslim. Which of the following would be most important for the nurse to integrate when providing care for this family? A) Rules are stricter for boys than for girls. B) Modest dressing is key for both men and women. C) Most Arabic women work outside the home. D) Most adhere to the three tenets of Islam.

Answer: Modest dressing is key for both men and women Rationale: For Muslims, modesty in dress is a core value for both men and women, although it is expressed more evidently by women. Rules are stricter for girls than for boys and most Arabic women stay at home and are not in the workplace. All practicing Muslims adhere to the five tenets of Islam.

A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community? A) Better job training B) Improved educational programs C) Expanded employment opportunities D) More community organizations

Answer: More community organizations Rationale: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.

A group of nursing students are studying for a test about various cultural communities. The students demonstrate that they understand the material when they identify which cultural group as believing in predestination? A) Hispanic/Latinos B) African Americans C) Muslims D) Native Americans

Answer: Muslims Rationale: Muslims believe in predestination, that life is determined beforehand, and they attribute the occurrence of disease to the will of Allah. Hispanic/Latinos believe that illness may be a form of punishment for sins. Some African Americans believe that illness is evidence of disharmony possibly due to evil spirits, punishment of God, or a hex placed on a person. Native Americans believe that health reflects living in total harmony with nature.

A community health nurse integrates understanding of power and empowerment when working with clients by demonstrating which of the following? A) Partnership with clients B) Hierarchical relationship C) Authority over clients D) Client autonomy

Answer: Partnership with clients Rationale: The various definitions of empowerment and the expansion of the definition of health, which now includes the social, political, and economic determinants of health, have changed our thinking on how best to interact with the communities we serve. This also suggests a change in the relationship between professionals and communities; a change from the customary hierarchical patient/provider relationship to one of a partnership.

An instructor is preparing a class presentation on landmark health legislation. Which of the following would the instructor include as the most significant legislation that attempts to ensure access to health care for Americans? A) Social Security Act B) Hill-Burton Act C) Patient Protection and Affordable Care Act D) Omnibus Budget Reconciliation Act

Answer: Patient Protection and Affordable Care Act Rationale: Patient Protection and Affordable Care Act is expected to provide access to health care for 30 million Americans when fully enacted. The Social Security Act had tremendous consequences for public health with revolutionary welfare insurance and assistance programs, the provision of financial assistance to form state and local health agencies. The Hill-Burton Act (1946), Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act (1981) are important acts that brought about changes in health care planning, safety, and funding.

Which stage in the policy process is exemplified by the activities of identifying the health problem and/or using a goal-oriented approach? A) Policy adoption B) Policy evaluation C) Policy formulation D) Policy implementation

Answer: Policy formulation Rationale: Policy formulation involves identifying goals, problems, and potential solutions. Policy adoption involves the authorized selection and specification of means to achieve goals, resolve problems, or both. Policy implementation follows adoption and occurs when the policy is put to use. Policy evaluation compares policy outcomes or effects with the intended or desired effects.

Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Public sector health care agencies are more likely to pilot or subsidize demonstration projects. B) Private sector health care agencies are more likely to promote health legislation. C) Public sector health care agencies are more likely to generate new research and innovation. D) Private sector health care agencies usually focus on needs that are met.

Answer: Private sector health care agencies are more likely to promote health legislation. Rationale: Private sector health agencies are more likely to promote health legislation, whereas public sector health care agencies are more likely to be responsible for carrying out health legislation. Private sector health care agencies (not public) are more likely to pilot or subsidize demonstration projects and generate new research and innovation. Private sector health care agencies strive to detect unmet needs rather than met needs.

Which statement regarding the potential impact of healthcare reform on community health nursing is most accurate? A) Health care reform does not affect community health nursing. B) Community health nurses know that outcomes research is unnecessary. C) Public health nurses can lead the effort in making health care more accessible to all citizens. D) Community health nurses will only be able to work in public health agencies.

Answer: Public health nurses can lead the effort in making health care more accessible to all citizens. Rationale: Public health nurses can lead the effort in making health care more accessible to all citizens. Health care reform definitely affects community health nursing. Community health nurses recognize the importance of outcomes research to document the value of nursing interventions with at-risk populations. Community health nursing has important ties to both private and public health agencies.

Which of the following statements about the core public health functions are true? A) Public health nurses practice as partners with other public health professionals within these core functions. B) Assessment involves the actual provision of services. C) Policy development relates to assessment. D) Assurance means that the public health agency must directly provide the needed services.

Answer: Public health nurses practice as partners with other public health professionals within these core functions. Rationale: Public health nurses practice as partners with other public health professionals within these core functions. Assessment does not involve the actual provision of services (assurance does). Public policy development builds on data from the assessment function. Assurance is the process of translating established policies into services. This function ensures that population-based services are provided, whether by public health agencies or private sources.

Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Private sector health services are complementary and supplementary to government health agencies. B) Public sector health care agencies usually meet the needs of people with special needs. C) Private sector health agencies usually are constrained in developing innovations in health care. D) Public health sector agencies generally satisfy the health care needs of a community.

Answer: Public sector health care agencies usually meet the needs of people with special needs. Rationale: Private sector health services are complementary and supplementary to government health agencies, but this is not a difference between the two types of agencies. Private sector health care agencies usually meet the needs of people with special needs (rather than public sector health care agencies that focus on the entire population within their jurisdiction). Private sector health care agencies are less constrained than public sector health care agencies in developing innovations in health care. A part of the reason for the development of private sector health care agencies is the impatience or dissatisfaction with government (public health) programs.

Community health nurses are attending an in-service program about health policy. Which of the following would the nurses expect to be included in the description? A) Reflection of a community's values B) Creation for several influential people C) Development by those outside of the community D) Indication of needs of the community's poor

Answer: Reflection of a community's values Rationale: Health policy should reflect a community's values and should not only be created for certain groups such as the influential or the poor. It needs to come from the people within the community and be for all of them.

Which one of the following statements about relative risk is most accurate? A) Lifestyle, behaviors, and choices do not relate to relative risk. B) Relative risk refers to exposure to risk factors identified from a substantial body of research. C) Relative risk means that if a risk exists, the illness or adverse event will occur. D) Any factor that is likely to cause increased risk is considered relative risk.

Answer: Relative risk refers to exposure to risk factors identified from a substantial body of research Rationale: Relative risk refers to exposure to risk factors identified from a substantial body of research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause and effect that if a risk exists, the illness or adverse event will occur. Only factors that are identified by a substantial body of research are considered relative risk.

Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients? A) Setting up an community agency clothing drive collection B) Working for changes in community attitudes C) Sending a personal donation to an agency in the area D) Remaining grounded

Answer: Sending a personal donation to an agency in the area Rationale: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.

Which of the following would the community health nurse identify as a drawback to retrospective reimbursement? A) Spending was limited to the most necessary tests and treatments. B) Services for sickness were encouraged rather than wellness. C) Consumers had to bear the increased accountability for cost containment. D) Payments for services were based on rates calculated from predictions.

Answer: Services for sickness were encouraged rather than wellness. Rationale: Retrospective payment is associated with encouraging sickness care rather than wellness services. Physicians and other providers were rewarded financially for treating illness and providing for additional tests and services. Patients and providers often insisted on expensive or unnecessary tests and treatment. Neither consumers nor providers were accountable for containing costs. Retrospective payment involves reimbursement for a service after it has been rendered with payment of a fee occurring after the fact.

Which one of the following statements is true regarding social capital? A) Social capital includes investments in individuals' capabilities and skills. B) Social capital includes marital status and family structure. C) Social capital includes jobs, income, housing, and education. D) Examples of social capital are education and job training.

Answer: Social capital includes marital status and family structure Rationale: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations. Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.

When describing public health nursing to a group of community health nurses, which of the following would be identified as its foundation? A) Social marketing B) Social justice C) Social disparities D) Advocacy

Answer: Social justice Rationale: The concept of social justice is seen as the very foundation of public health nursing. Social marketing is the means to influence behavior of target populations for program development. Addressing social disparities or inequalities are one component of public health nursing. Advocacy involves pleading the case of another and pursuing influencing outcomes.

After describing the Public Health Service to a group of students, which description would indicate the need for additional discussion? A) It offers consultation through national advisory health councils and special advisory committees made up of lay experts. B) The Secretary of Health and Human Services is ultimately responsible for it. C) The Secretary of Health and Human Services is an elected position. D) A major function is to administer grants and contracts with other government agencies.

Answer: The Secretary of Health and Human Services is an elected position Rationale: The Secretary of Health and Human Services is a cabinet position. Cabinet positions are appointed by the President. The Public Health Service does offer consultation through national advisory health councils and special advisory committees made up of lay experts. The Secretary of Health and Human Services is ultimately responsible for the Public Health Service. A major function of the Public Health Service is to administer grants and contracts with other government agencies.

Which of the following most well describes a public health care agency? A) The agency most often has a very specific focus. B) The agency is responsible for promoting and protecting the health of all within their jurisdiction. C) The agency only employs nurses and environmental health practitioners. D) The agency is able to perform its work independently with complete autonomy.

Answer: The agency is responsible for promoting and protecting the health of all within their jurisdiction. Rationale: Unlike private organizations that tend to have a specific focus, government health agencies exist to accomplish a broad goal of protecting and promoting the health of the total population under their jurisdiction. Public health requires interdisciplinary and interorganizational collaboration.

Which of the following statements about the international health organization is most accurate? A) PAHO is completely separate from the WHO. B) UNICEF promotes child and maternal health and welfare globally. C) WHO focuses primarily on developing countries. D) WHO and UNICEF are agencies of the United Nations.

Answer: UNICEF promotes child and maternal health and welfare globally Rationale: United Nations International Children's Emergency Fund (UNICEF) promotes child and maternal health and welfare globally. The Pan American Health Organization (PAHO) is the oldest continually functioning international health organization in the world and predates the World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is now the WHO regional office for the Americas and receives part of its funding from WHO. WHO focuses on the promotion of health worldwide, not just developing countries. The United States Agency for International Development (USAID) focuses on developing countries. WHO and UNICEF are both agencies of the United Nations.

Which one of the following statements is true regarding the socioeconomic gradient of health? A) The behavior of smoking is lowest among those who have low income and low educational levels. B) The socioeconomic gradient of health has been found in populations around the world. C) All persons who have a low socioeconomic status will develop particular health problems. D) The socioeconomic gradient of health is universal.

Answer: The socioeconomic gradient of health has been found in populations around the world. Rationale: The socioeconomic gradient of health has been found in populations around the world, although not always unfailingly. The behavior of smoking is highest among those who have low income and low educational levels. Not all persons who have low socioeconomic status will develop particular health problems.

Which of the following would a community health nurse use to define vulnerable populations? A) Those persons with higher mortality rates B) Individuals with lower life expectancy C) Those with increased risk for adverse health outcomes D) Individuals with chronic illness

Answer: Those with increased risk for adverse health outcomes Rationale: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, presence of just one of these does not necessarily indicate that the population is vulnerable.

A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective? A) Keeping the clients to a firm schedule of visits B) Viewing the clients as active partners in the process C) Having the clients cut through bureaucratic red tape D) Focusing on the clients' limitations

Answer: Viewing the clients as active partners in the process Rationale: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).

A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful? A) Increase use of early screenings B) Increase emergency room visits C) Increase episodic care D) Increase disparities in care

Answer: increase use of early screenings Rationale: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.

When describing managed competition as a potential solution to resolve the healthcare crisis, which of the following would be included? Managed competition would A) promote cost containment and universal access to health care. B) eliminate burdensome government regulations. C) reduce state and federal control over health care delivery. D) discourage consumers from making responsible choices.

Answer: promote cost containment and universal access to health care. Rationale: Managed competition ideally would promote cost containment and universal access to health care. Governmental regulations and control would still be present as would insurance companies. Managed care would encourage consumers to make responsible choices.

When seeking employment, a community health nurse decides to focus the search on official health care agencies, based on the understanding that these agencies are A) voluntary. B) tax supported. C) proprietary. D) privately funded.

Answer: tax supported Rationale: Official health care agencies, later called public health agencies, are tax supported; thus, they must provide services determined by the federal, state, or local government. Voluntary or private agencies are privately funded. Proprietary health services are privately owned and managed and may be for profit or nonprofit.

During a presentation at a local health department, a community health nurse discusses how society has changed over the past 100 years and the influence that these changes have had on the community's health care needs. Which of the following would the nurse include as a current societal event? A) Large disparity in male/female wages B) Rural to urban migration C) Rampant child labor D) Widespread violence

Answer: widespread violence Rationale: Today, society is faced with widespread violence and terrorism. Populated urban areas continue to loose people to the suburbs, while 100 years ago, people were leaving rural areas for urban areas. A century ago child labor laws were just forming and child labor was rampant.

A community health nurse primarily works with mothers and their high-risk children, often referring them to various voluntary agencies for services. Which of the following would be examples of voluntary health agencies? Select all that apply. A) American Diabetes Association B) The U.S. Public Health Service C) The National Institutes of Health D) Women, Infant, and Children Program (WIC) E) National Society for Autistic Children F) Planned Parenthood Federation of America

Answers -American Diabetes Association - National Society for Autistic Children - Planned Parenthood Federation of America Rationale: The American Diabetes Association, National Society for Autistic Children, and Planned Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and are nonprofit organizations. The U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal agencies or receive federal funds to operate; thus they are not voluntary agencies.

As part of a community wide education program, a community health nurse is developing a teaching plan about Medicare. Which of the following would the nurse include in the plan? Select all that apply. A) It is a state health insurance program for elderly and the disabled. B) Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services. C) Medicare Part D covers prescription drug costs. D) Medicare Part A is supplementary and voluntary. E) Medicare beneficiaries can make changes to their coverage at any time.

Answers -Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services. -Medicare Part D covers prescription drug costs. Rationale: Medicare is a federal health insurance program and covers citizens and some legal aliens who are over 65 years old (not a State program). It also covers people with permanent disabilities or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing service. Prescriptions are covered under Medicare Part D. Medicare Part B is supplementary and voluntary. Medicare beneficiaries can make changes to their coverage during open enrollment periods.

Which of the following statements about advocacy and lobbying and the influence of both on policy are true? Select all that apply. A) Advocacy can be defined as pleading the case of another or championing a cause. B) Lobbying is the act of influencing legislators. C) Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. D) Policy and politics are not related to each other. E) Public policy is a rational process.

Answers: -Advocacy can be defined as pleading the case of another or championing a cause. -Lobbying is the act of influencing legislators. -Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. Rationale: Advocacy can be defined as pleading the case of another or championing a cause. Lobbying is the act of influencing legislators. Nurses can gain access to legislators individually or through the services of a professional lobbyist or PAC. Policy and politics go hand in hand; neither exists without the other. Public policy is not a rational process.

Which of the following statements about special interest groups and policy making are true? Select all that apply. A) Others will be persuaded by facts alone. B) Power is wielded by special interest groups, business, and industry. C) Nurses need to provide input to policy circles through advocacy. D) Nurses need to provide leadership at decision-making tables. E) There are power struggles behind all legislation and health care regulation.

Answers: -Power is wielded by special interest groups, business, and industry. -Nurses need to provide input to policy circles through advocacy. -Nurses need to provide leadership at decision-making tables. -There are power struggles behind all legislation and health care regulation. Rationale: Nurses need to provide input to policy circles through advocacy and leadership at decision-making tables. It is naïve to believe that others will be persuaded by facts alone. Power is wielded by special interest groups, business, and industry. There are power struggles behind all legislation and health care regulation.

Which of the following statements reflect progress in public policy that can be attributed to professional nursing organizations? Select all that apply. A) Professional nursing organizations have elevated nursing professionalism. B) Professional nursing organizations have given voice to the inequalities that affect our society. C) Professional nursing organizations have developed the paradigms that influence and affect public health. D) Nursing is regarded as a major player in Washington when discussing health care policy. E) Professional nursing organizations have a long and consistent relationship with public policy.

Answers: -Professional nursing organizations have elevated nursing professionalism. -Professional nursing organizations have given voice to the inequalities that affect our society. -Professional nursing organizations have developed the paradigms that influence and affect public health. Rationale: Professional nursing organizations have elevated nursing professionalism, have given voice to the inequalities that affect our society, and have developed the paradigms that influence and affect public health. Despite nursing's early history of political activism and the fact that nurses are the largest group of health care providers in the United States, widespread political involvement has yet to be fully realized.

When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply. A) Resource availability B) Relative risk C) Health status D) Housing E) Education

Answers: -Resource availability -Relative risk -Health status Rationale: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.

. A group of students are preparing for an examination on the various events serving as landmarks for health care legislation. The students demonstrate understanding of these events by identifying which of the following statements about particular landmark health legislation are true? Select all that apply. A) The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. B) The Shepard-Towner Act provided funds to states for hospital construction. C) The Hill-Burton Act provided funds to states for administration of programs to support the health and welfare of mothers and infants. D) The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of medical records.

Answers: -The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. -The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. -The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. Rationale: The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. The Hill-Burton Act provided funds to states for hospital construction. The Shepard-Towner Act provided federal funds to states for administration of programs to support the health and welfare of mothers and infants. The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. The Health Insurance Portability and Accountability Act attempted to ensure the privacy of medical records.

Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply. A) HIV-infected persons B) Persons who use illicit drugs C) People of non-White race/ethnicity D) People of White race/ethnicity E) Homeless persons

Answers: - HIV-infected persons -Persons who use illicit drugs -People of non-White race/ethnicity -Homeless persons Rationale: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.

Over the past century, many health-related changes have occurred affecting morbidity and mortality. As community health nurses assess and plan for services in the community, an understanding of which of the following changes would the nurses need to integrate into their plans? Select all that apply. A) High levels of chronic disease B) Shortened life spans C) Increased teen pregnancies D) Abuse of multiple substances E) Increased maternal mortality F) Multidrug-resistant diseases

Answers: -High levels of chronic disease -Increased teen pregnancies -Abuse of multiple substances -Multidrug-resistant diseases Rationale: Issues today include high levels of chronic disease, increase in teen pregnancies, abuse of multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal mortality were real issues in the 1900s but are significantly different today. With the shortened life span over 100 years ago, people were not living long enough to develop a long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and the technology of today did not exist.

Which of the following statements about power and empowerment are true accurate? Select all that apply. A) Power is the ability to act or produce an effect and possess control, authority, or influence over others. B) Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. C) If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. D) All of the power belongs to the legislators. E) Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.

Answers: -Power is the ability to act or produce an effect and possess control, authority, or influence over others. -Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. -If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. -Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities. Rationale: Power is the ability to act or produce an effect and possess control, authority, or influence over others. Empowerment is a process of assisting communities to come together to express their values and ideas to those outside the community. If power is the ability to control, predict, and participate in one's environment, then empowerment is the process whereby individuals and communities take power and transform their lives. Professionals hold the power and authority by virtue of their place in the bureaucracy. Nurses have a responsibility to ensure community participation in issues affecting them, and they must continually examine the relationship and position they hold within these communities.

Which of the following would be important for a politically involved nurse to do? Select all that apply. A) Communicate ideas effectively B) Get to know local representatives C) Avoid involvement with community boards D) Be firm and unyielding in approach E) Stay current about health care issues

Answers: -Communicate ideas effectively -Get to know local representatives -Stay current about health care issues Rationale: The politically involved nurse should aim to accomplish three primary goals: (1) generate support for one's views by communicating ideas effectively and getting to know and influence representatives at local, state, and national levels; (2) create professional legitimacy by keeping abreast of current issues in health care and nursing and becoming involved in professional nursing organizations, community boards or committees, or political office at the local, state or national level; and (3) resolve conflict and effectively negotiate and compromise.

Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply. A) Patients feel that they are unable to trust the information given to them and may not follow it as explained. B) Limited access to appropriate level of care C) Poor access to quality care D) Overt discrimination E) Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts

Answers: -Patients feel that they are unable to trust the information given to them and may not follow it as explained. -Limited access to appropriate level of care -Poor access to quality care -Overt discrimination Rationale: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected. Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.

. Which of the following statements about the impact of research on community health nursing are true? Select all that apply. A) It is important to conduct research to affect public policy. B) Public policy will continue to have a negative effect on the community's health. C) Research will affect the effectiveness of community health nursing practice. D) Research will affect the status and influence of nursing as a profession. E) The impact that research has on community health nursing is negligible.

-It is important to conduct research to affect public policy -Research will affect the effectiveness of community health nursing practice -Research will affect the status and influence of nursing as a profession Rationale: Research has the potential to have a significant impact on community health nursing in three ways: by affecting public policy and the community's health, the effectiveness of community health nursing practice, and the status and influence of nursing as a profession. Community health nurses have been involved in research addressing all three of these dimensions.

Which of the following are important contributions made by Lillian Wald to the profession of public health nursing? Select all that apply. A) Demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children B) Promoting the use of birth control C) Convincing the Metropolitan Life Company that nurse intervention could reduce death rates D) Providing rural "frontier nursing" to serve mountain families in Kentucky E) Founding the National Organization for Public Health Nursing (NOPHN)

A. Demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children C. Convincing the Metropolitan Life Company that nurse intervention could reduce death rates E. Founding the National Organization for Public Health Nursing (NOPHN) Rationale: Lillian Wald contributed to the profession of public health nursing by demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children, convincing the Metropolitan Life Company that nurse intervention could reduce death rates, and Founding the National Organization for Public Health Nursing (NOPHN).

After teaching a group of nursing students about the similarities and differences between public health and community health, which of the following statements by a nursing student would indicate knowledge of the similarities and differences between public health and community health? A) "Community health nursing is defined as nursing care that is provided in a community setting, rather than an institutional setting." B) "Public health nursing is defined as nursing care that is provided in an institutional setting." C) "Public health nursing is focused on the health of individuals." D) "Community health nursing can shape the quality of community health services and improve the health of the general public."

Answer: "Community health nursing can shape the quality of community health services and improve the health of the general public." Rationale: Operating within an environment of rapid change and increasingly complex challenges, this nursing specialty holds the potential to shape the quality of community health services and improve the health of the general public.

After discussing the meaning of cultural diversity and its significance for community health nursing, the nursing instructor recognizes that some points need to be clarified when a student makes which of the following comments? A) "Dominant values are those held by the male head of the household in most American families." B) "The percentages of White European descent Americans are rising, while the percentages of other ethnicities are declining and this is projected to continue into the year 2050 at least." C) "Nurses maintain their original culture as they are socialized throughout the educational process." D) "America has become an amalgamation of people who have different values, ideals, and behaviors, rather than the melting pot that was once envisioned."

Answer: "Dominant values are those held by the male head of the household in most American families." Rationale: The beliefs and sanctions of the dominant or majority culture are called dominant values. The proportion of the population identified as White is projected to continue to fall below other ethnicities between 2010 and 2050. Nurses will still have the same culture as they did before they were socialized in the nursing educational process, but they may be able to see things differently. America is not the ideal melting pot once described, but rather an amalgamation of people who have different values, ideals, and behaviors.

As a community health nurse, you overhear a colleague say, "I don't understand why the Yang's take their young teenage daughters to the Hmong New Year celebration and have them play these match-making games. The girls meet boys every day at school and they are too young to be looking for husbands." Which of the following would be the most appropriate response? A) "The Yang's are very different from us; maybe in time we can convince them that their practices are not right." B) "Every culture has its differences; I think it is valuable that the Yang's are keeping their cultural practices alive." C) "I know what you mean, I was thinking the same thing. You wouldn't catch me doing something similar with my teens." D) "I feel sorry for those girls; they must feel funny in those cultural costumes. Let's talk to the parents and tell them how teens in America feel about such things."

Answer: "Every culture has its differences; I think it is valuable that the Yang's are keeping their cultural practices alive." Rationale: Community health nurses need to develop cultural sensitivity, becoming aware of own biases and preconceived values and beliefs. This would be evidenced by the statement about every culture having differences. The celebration is a part of the family's culture, and the nurses should not attempt to convince them that it is not right nor should they attempt to impose their views, feelings, or beliefs on the family.

While interviewing a client, which of the following statements would a nurse identify as reflecting an objective dimension of health? A) "I'm feeling better since I started taking that medication." B) "Life is pretty good right now, except for an occasional upset stomach." C) "I'm able to wash myself in the mornings with just a bit of help." D) "Sometimes when I wake up, I don't even want to face the day."

Answer: "I am able to wash myself in the mornings with just a bit of help." Rationale: The objective dimension of health involves one's ability to function in daily activities. The statement about being able to care for one's self is an example. The statements of feeling better with medication, life being pretty good, and not wanting to face the day are examples of the subjective dimension of health, which involves how people feel.

A public health nurse is faced with an ethical dilemma. Which question should the nurse consider first when deciding how to resolve the dilemma? A) "What exactly is the ethical dilemma?" B) "What are the alternative courses of action?" C) "What are the consequences of each alternative courses of action?" D) "How should this dilemma be solved?"'

Answer: "What exactly is the ethical dilemma?" Rationale: A framework is applied in public health ethics inquiry. Three core functions of this inquiry include (1) identifying and clarifying the ethical dilemma, (2) analyzing it in terms of alternative courses of action and their consequences, and (3) resolving the dilemma by deciding which course of action best incorporates and balances the guiding principles and values.

Which of the following is most accurate about the concept of community? A) A community is a collection of people who share some important features of their lives. B) Community members live in the same geographic location. C) Community members are biologically related. D) A community is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

Answer: A community is a collection of people who share some important features of their lives. Rationale: The broad definition of a community is a collection of people who share some important features of their lives. Community members may not live in the same geographic location as in a common-interest community or a community of solution. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

The nurse is working with a community of solutions. Which of the following would the nurse expect to find? A) A health problem affecting the group B) Common goal binding members together C) Sharing of a similar goal D) Locational boundaries

Answer: A health problem affecting the group Rationale: A community of solution involves a group of people coming together to solve a problem that affects them. A common-interest community involves a collection of people widely scattered geographically who have an interest or goal that binds the members together. A geographical community is one defined by its geographical or locational boundaries.

The term health can be described in many different ways. A community health nurse would view health as which of the following? A) The absence of disease B) The potential to lead a productive life C) An environment free of toxins D) A holistic state of well-being

Answer: A holistic state of well-being Rationale: Community health nurses view health as a holistic state of well-being, which includes soundness of mind, body, and spirit. Along with this foundational view is the emphasis on wellness, which includes the definition of health as well as the capacity to develop a person's potential to lead a fulfilling and productive life. Health is more than just the absence of disease or an environment free of toxins

Which of the following statements is an accurate description of the characteristic shared by all cultures, culture is integrated? A) A person's culture is an interrelated and interdependent web of ideas and practices. B) In order to describe a person's culture, it is necessary to describe each trait independently. C) Aspects of a person's culture are best described as unrelated to other aspects of the person's culture. D) A person's culture is an assortment of various customs and traits.

Answer: A person's culture is an interrelated and interdependent web of ideas and practices. Rationale: A person's culture is an integrated web of ideas and practices. To understand culture, single traits should not be described independently. As in any system, all parts of a culture are interrelated and interdependent.

The community health nurse is preparing a presentation for a group of nursing students about the societal influences on the development of community health nursing. Which factors should the nurse include that have influenced the growth of community health nursing? Select all that apply. A) Advances in the technology B) The recognition that one single agent could be considered a cause of illness C) Access to education being limited to the privileged few D) Continued increase in the number of women entering nursing because it is recognized as a choice career for women and not men E) Consumer demand for quality services coupled with community health nurses provision of holistic care

Answer: Advances in the technology, consumer demand for quality services coupled with community health nurses provision of holistic care Rationale: Many factors have influenced the growth of community health nursing, including advances in technology, progress in causal thinking (relating disease or illness to its cause and recognition that many factors might contribute to a disease or health disorder), and the consumer movement with consumers demanding quality services. Education is now widely available and is considered a basic right and necessity for a vital society. Changing demographics and the role of women have influenced community health nursing; however, the number of women entering nursing has decreased.

While providing care to a family at a local center, the community health nurse contacts the local department of social services to help the family attain assistance with health insurance coverage. The nurse also gives the family a list of pharmacies where they can get their prescriptions filled. The nurse is acting in which role? A) Educator B) Leader C) Clinician D) Advocate

Answer: Advocate Rationale: The nurse is acting in the role of advocate, by pleading their cause and acting on their behalf. The nurse acts as an advocate by showing clients what services are available, the ones to which they are entitled, and how to obtain them. As an educator, the nurse is the health teacher and provides information to community clients. As a leader, the nurse directs, influences, or persuades others to effect change that will positively impact people's health and move them toward a goal. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations.

A community health nurse discovers that a bill in the legislature would eliminate a state law that currently funds child health promotion services for low-income children. Which action at the primary level of prevention would be most appropriate? A) Advocate for amendment to the passed law to allow some funding for children to remain B) Once the bill has been passed, seek private resources to support funding of health promotion services for low-income children. C) Gather a group of health professionals to volunteer to provide the health promotion services eliminated by the passed bill D) Advocate through active lobbying against the bill and gather community support

Answer: Advocate through active lobbying against the bill and gather community support Rationale: Appropriate activities at the primary level of prevention would include actively lobbying against the bill, garnering community support in favor of the revised bill, and advocating for the clients. Advocating for amendments would be appropriate at the secondary level. Seeking private resources and gathering volunteers to provide the health services would be appropriate at the tertiary level.

A community health nurse is involved in a project to evaluate the health of a city. Which of the following findings would suggest that the city would most likely need additional programs? A) Citizens are actively involved in the city's department of recreation and after-school programs. B) The construction of affordable organized housing developments and communities is nearing completion. C) Approximately one third of the people are recently unemployed due to closure of the automotive factory. D) Several new recreational facilities for adults and children have been created at several locations.

Answer: Approximately one third of the people are recently unemployed due to closure of the automotive factory Rationale: A healthy city is one in which there is continual creation and improvement of the physical and social environments with expansion of community resources so that people can mutually support one another. It is characterized by the meeting of basic needs for all of the city's people. This would include food, water, shelter, income, safety, and work. Loss of employment of one third of the city's workforce would be a threat to the health of the city and necessitate intervention. Active involvement in the city's functioning, affordable housing, and recreational facilities are suggestive of a healthy city.

When employing a population-oriented focus, the community health nurse would do which of the following? A) Assess the groups' relationships looking for a common need. B) Consider the members individually for similarities. C) Focus on the geographical area of the population. D) Promote the groups' dependency for improving health.

Answer: Assess the groups' relationships looking for a common need Rationale: A population-oriented focus requires the assessment of relationships, considering the groups or communities in relationship to the rest of the community to discover common needs or risks for a common health problem. The nurse does not consider the groups or communities separately but rather in context. The population may or may not be delineated by the geographical area. The community health nurse encourages individuals' participation to promote their autonomy rather than permitting dependency.

A nurse is planning a research study to answer a clinical question. Which of the following would be most appropriate for qualitative research approach? A) Evaluating the reported cases of post vaccination complications after varicella immunization B) Determining the use of complementary and alternative health care by middle-aged adults in rural areas C) Ascertaining the effect of using calming music on older adults with dementia in extended care facilities D) Assessing the emotional responses and feelings of individuals requiring isolation due to a highly communicable illness

Answer: Assessing the emotional responses and feelings of individuals requiring isolation due to a highly communicable illness Rationale: Qualitative research is used to study those areas that need a broader focus or that do not lend themselves to objective measurement. This type of research emphasizes subjectivity and the meaning of the experiences to individuals. Thus, qualitative research would be most appropriate for assessing the emotional responses and feelings of individuals who require isolation for a communicable illness. Quantitative research would be used to evaluate the reported cases of post-vaccination complications, to determine the use of complementary and alternative health care, and to ascertain the effect of calming music.

A community health nurse is collaborating with local community leaders to prepare a community disaster plan. Which function is the nurse fulfilling? A) Research B) Assurance C) Policy development D) Assessment

Answer: Assurance Rationale: Community health nurses perform the assurance function at the community level when they collaborate with community leaders in the preparation of a community disaster plan. Research is demonstrated by gaining new insights and innovative solutions to health problems. Policy development would involve client information, education and empowerment, mobilization of community partnerships, and the development of plans and policies to support community health efforts. Assessment involves monitoring health status for community health problems and diagnosing and investigating health problems and hazards in the community.

A prospective nursing student is interested in working in community health nursing after graduation. Which type of education would be most appropriate for this student to choose? A) Diploma program B) Associate degree C) Baccalaureate degree D) Graduate degree

Answer: Baccalaureate degree Rationale: Community health nursing is a challenging specialty in nursing. The demands of this type of nursing require additional courses in liberal arts and science, along with courses in community health nursing practice as a student. The minimum preparation for community health nurses in many states is a baccalaureate degree. The diploma and associate degree level prepares students for basic nursing practice. Students can build on this basic knowledge by entering a BSN completion program, which will prepare them to enter the specialty of community health nursing. In order to stay current and to build skills in this specialty, advanced courses or a graduate (masters) degree is needed.

Application of nursing research results to community health nursing practice is essential. Which of the following must occur first before results can be applied? A) Be informed about research findings B) Demonstrate skill in examining research reports C) Assess abstracts of relevant research studies D) Check if the study was funded by a drug company

Answer: Be informed about research findings Rationale: Community health nurses have many opportunities to apply the results of other investigator's research, but a necessary prerequisite is that the nurse must be informed about research findings. Critically examining research reports and assessing abstracts are all part of evaluating relevant research studies. However, the nurse needs to know what the research findings are before he or she can evaluate the research. Checking if the study was funded by a drug company might indicate that the results of the study could be questioned due to a conflict of interest.

At which time did the focus of district nursing broadened to include the health and welfare of the general public? A) Beginning of 20th century B) In the late 19th century C) Prior to the 1850s D) By the early 1970s

Answer: Beginning of 20th century Rationale: The focus of district nursing broadened to include the health and welfare of the general public by the beginning of the 20th century or the early 1900s. In the late 19th century, district nurses were ill-prepared to cope with their clients' multiple health and social problems resulting from widespread immigration and filled tenement housing that led to inadequate sanitation, unsafe and unhealthy working condition, and barriers adding to poverty and disease. District nursing did not develop until after 1850. The early 1970s is associated with the emergence of community health nursing.

A community health nurse is engaging in assurance activities. Which of the following would best explain these activities? A) Gathering and analyzing information that will affect the health of the people to be served B) Providing leadership in facilitating community groups toward meeting their needs, often involving changes in and additions to existing laws C) Being involved in activities to make certain that necessary services are being provided to the community D) Accessing relevant data that enable identification of strengths, weaknesses, and needs within the community

Answer: Being involved in activities to make certain that necessary services are being provided to the community Rationale: Assurance activities are those activities that make certain that services are provided and include focusing on the availability of necessary health services throughout the community, maintaining the ability of public health agencies and private providers to manage day-to-day operations as well as the capacity to respond to critical situations and emergencies. Assessment involves gathering and analyzing information that will affect the health of those to be served and accessing relevant data to enable the nurse to identify strengths, weaknesses, and needs. Policy development involves providing leadership in facilitating community groups.

A community health nurse is working to support programs to encourage preschool immunizations. The nurse is integrating which ethical principle in his or her practice? A) Beneficence B) Autonomy C) Nonmaleficence D) Justice

Answer: Beneficence Rationale: Beneficence means doing good or benefitting others, such as supporting programs to encourage preschool immunizations. Autonomy means freedom of choice and exercise of people's rights, such as promoting individuals' and groups' rights to and involvement in decision making. Nonmaleficence means avoiding or preventing harm to others as a consequence of a person's own choice and actions, such as encouraging physicians to prescribe drugs with the fewest side effects. Justice refers to treating people fairly, such as ensuring equal access to health care.

A nursing instructor is preparing a teaching plan for a class comparing evidence-based practice and critical thinking. Which of the following would the instructor include? A) Evidence-based practice and critical thinking are polar opposites. B) Both involve problem clarification of central concepts. C) Interpretation of accumulated evidence is unique to evidence-based practice. D) Problem exploration is unique to evidence-based practice.

Answer: Both involve problem clarification of central concepts. Rationale: Evidence-based practice and critical thinking share commonalities including exploring a problem, addressing a purpose or goal, making assumptions, clarifying the problem around central concepts or indicators, accessing data, interpreting accumulated evidence, using reasoning, processing, defining, planning and documenting, acting on the problem, and evaluating, adjusting, generalizing, and applying to a broader problem set. In addition, critical thinking is an important component of evidence-based practice.

Before the mid-1800s, early home care nursing was best recognized by which of the following? A) Technical advances with the Industrial Revolution making major changes B) Care provided by family members, friends, and religious groups in the home C) Accomplishments stemming from the work of Florence Nightingale D) Formal organization of visiting nursing to provide care to the sick poor

Answer: Care provided by family members, friends, and religious groups in the home Rationale: Before the mid-1800s, early home care was characterized by care of the sick in the home by family members, friends, and religious groups. Technical advances came after 1850, as did the work of Florence Nightingale and the formal organization of visiting nurses to provide care to the sick poor.

Which of the following would the community health nurse do first when making an ethical decision? A) Engage in critical thinking B) Choose a value C) Identify isolated values D) Clarify one's values

Answer: Clarify one's values Rationale: Clarification of a person's values is the first step in the process of ethical decision making. Critical thinking is a strategy that can be used to help clarify values. Choosing a value is the first step in the process of valuing. Identifying isolated values are those which are organized into a hierarchical system where certain values have more weight or importance than others

A community health nurse is interviewing for employment. The interviewer describes some of the typical activities that the nurse would be involved in, such as making home visits to families, holding immunization clinics for infants and children, and setting up flu-shot clinics for elders. The interviewer is describing which role? A) Educator B) Advocate C) Clinician D) Manager

Answer: Clinician Rationale: The interviewer is describing direct care activities associated with the clinician role. As an educator, the nurse is the health teacher and provides information to community clients. In the advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals.

A nurse in community health nursing setting works with police officers, social workers, health educators, and other nurses to promote the health of clients. The nurse is acting in which role? A) Clinician B) Educator C) Researcher D) Collaborator

Answer: Collaborator Rationale: The nurse is assuming the role of collaborator. In this role, the community health nurse works jointly with many individuals to benefit client care. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations. As an educator, the nurse is the health teacher and provides information to community clients. In the researcher role, the community health nurse engages in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice.

A group of students are reviewing material for a test on populations, communities, and aggregates. Which of the following indicates that the students understand these concepts? A) Members of a population share a sense of belonging. B) Communities and populations are types of aggregates. C) Individuals of a community are loosely connected. D) Members of an aggregate share a strong bond.

Answer: Communities and populations are types of aggregates. Rationale: An aggregate refers to a mass of grouping of distinct individuals who are considered as a whole and who are loosely associated with one another. Communities and populations are types of aggregates. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to the group. A community is a collection of people who chose to interact with one another because of common interests, characteristics, or goals, which form the basis for a sense of unity or belonging.

A community health nurse is working as a lobbyist for health legislation for AIDS research at the state capital. This nurse is practicing in which setting? A) Faith community B) Ambulatory service C) Residential institution D) Community at large

Answer: Community at large Rationale: The community at large is not confined to a specific philosophy, location, or building. It serves as the setting for practice of a nurse who serves on health care planning committees, lobbies for health legislation at the state capital, runs for a school board position, or assists with flood relief in another state or country. Faith community nursing focuses on activities involving the faith community and religious belief system. Ambulatory service settings include a variety of venues in which clients come for day or evening services that do not include overnight stays. Residential institutions include any facility where clients reside.

A community health nurse who is teaching a group of nursing students about the various societal influences on community health nursing is explaining the effects of the consumer movement. Which of the following student responses would lead the community health nurse to determine that the teaching was successful? A) Individuals are considered passive members of the health care team. B) Consumers are demanding more coordinated comprehensive care. C) People are expecting community health nurses to develop new programs. D) Consumers are identifying a greater need for care by a variety of care providers.

Answer: Consumers are demanding more coordinated comprehensive care Rationale: The consumer movement has led to changes in community health nursing. Consumers are demanding more humane, personalized health care, seeking more comprehensive coordinated care. They are viewed as active members of the health care team. The need to develop new programs is a response to the economic forces that have affected the practice of community health nursing. Consumers desire more coordinated care, not care from a variety of care providers.

A community health nurse is working with other members of a team that will be implementing a citywide immunization program. The nurse is coordinating the services and addressing the needs of the population groups to ensure which of the following? A) Involvement of the community B) Client participation C) Continuity of service D) Plan for follow-up

Answer: Continuity of service Rationale: Working in cooperation with other team members and coordinating services and addressing the needs of population groups are essential to interprofessional collaboration. In doing so, the community health nurse is preventing fragmentation and gaps thereby ensuring continuity of service. Involvement of the community and client participation are important but these help to ensure that the clients are viewed as equal partners of the health care team. A plan for follow-up may or may not be appropriate. In addition, it is the only aspect that may be addressed with the program.

As part of a class presentation, a nursing instructor describes the characteristics shared by all cultures. Which description of culture being tacit indicates that the teaching was successful? A) Culture is mostly unexpressed. B) Cultures do not remain static. C) Culture is a functional and integrated whole. D) Patterns of cultural behavior are acquired

Answer: Culture is mostly unexpressed Rationale: Culture is tacit, that is, mostly unexpressed and at the unconscious level. Culture is dynamic, undergoing change and never entirely static. It is integrated and learned.

Which of the following statements about health promotion and disease prevention is the most accurate? A) Health promotion and disease prevention include all efforts that seek to move people closer to optimal well-being or higher levels of wellness. B) Disease prevention differs from health promotion in that disease prevention is targeted toward a specific disease or diseases. C) Health promotion can be described in terms of primary, secondary, and tertiary prevention. D) The goal of disease prevention is to raise levels of wellness for individuals, families, populations, and communities.

Answer: Disease prevention differs from health promotion in that disease prevention is targeted toward a specific disease or diseases. Rationale: Health promotion includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness. The goal of health promotion is to raise levels of wellness for individuals, families, populations, and communities. Disease prevention is targeted toward a specific disease or diseases and consists of primary, secondary, and tertiary prevention.

A community health nurse desires to attain a tenure-track position at a local university to teach community health nursing. Which of the following would this nurse need? A) Certification B) Master's degree C) Doctoral degree D) Nurse practitioner license

Answer: Doctoral degree Rationale: A doctoral degree would be the required education needed to obtain a tenure-track teaching position at a university. Certification provides additional education for specialization and may result in a promotion or higher salary accompanied by additional responsibilities and opportunities. A master's degree can lead to management positions, private community health ownership, agency teaching, or research positions. Nurse practitioners can run well-child clinics and direct a school-based clinic if a school nurse. Advanced practice can open doors into leadership positions in community health nursing.

. The community health nurse is engaging in the core function of policy development. With which of the activities would the nurse most likely be involved? A) Monitoring health status to identify community health problems B) Empowering communities about important health issues C) Linking individuals to needed personal health services D) Ensuring a competent health care workforce is available

Answer: Empowering communities about important health issues Rationale: With policy development, the community health nurse would be involved in informing, educating, and empowering people about health issues. Monitoring health status is associated with the assessment function. Linking individuals to needed personal health services and ensuring a competent public health and personal health care workforce are associated with assurance.

Which of the following statements about basic values that guide decision making in community health nursing is true? A) Client empowerment means that the provider must use a paternalistic approach to health care. B) Self-interest does not interfere with self-determination. C) When matters of well-being are considered, the client's preferences and needs should not be considered. D) Equity is not possible in times of limited resources.

Answer: Equity is not possible in times of limited resources In times of limited technical, human, and financial resources, however, it may be impossible to fully respect the value of equity. Client empowerment is an approach that differs from the paternalistic approach to health care in which decisions are made for, rather than with, the client; instead, it enables patients and professionals to work in partnerships. When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care. Well-intended interventions sometimes fall short if they are in conflict with clients' preferences and needs.

Which of the following would a community health nurse identify as a community of common interest? A) The global community B) Small rural town in a northern state C) National professional organization D) Counties addressing water pollution

Answer: National professional organization Rationale: A common-interest community shares a common interest or goal that binds the members together. Membership in a national professional organization is one example. The global community and a small rural town in a northern state would be examples of a geographic community. Counties addressing a water pollution problem would be an example of a community of solution.

After a class discussion about the contributions of Lillian Wald to the advancement of community health nursing, which of the following if stated by the class indicates that the discussion was effective? A) Establishment of family-centered nursing and outreach services in New York City at the turn of the 20th century B) Use of clean and safe nursing care practices to soldiers during the Crimean War in the 1850s C) Assistance to high-risk populations experiencing tropical diseases in Central America and the Caribbean in the late 1800s D) Creation of home nursing services in London, marking the beginning of district nursing in the 1860s

Answer: Establishment of family-centered nursing and outreach services in New York City at the turn of the 20th century Rationale: Lillian Wald worked with immigrant families in the Lower East Side of New York City, providing home visits, a neighborhood center, and general sanitation improvement for families and health care services to children in schools. Florence Nightingale was responsible for providing clean and safe nursing care practices to soldiers during the Crimean War. Mary Seacole helped high-risk populations who experienced tropical diseases in Central America and the Caribbean. William Rathbone was responsible for establishing a visiting nurse service for the sick in London.

While providing care to a community group, a community health nurse provides culturally sensitive care by avoiding which of the following? A) Ethnocentrism B) Ethnorelativism C) Enculturation D) Ethnicity

Answer: Ethnocentrism Rationale: Ethnocentrism is the belief or feeling that one's own culture is best causing the person to believe that his or her way of doing things is right and to judge others' methods as inferior, ignorant, or irrational. It blocks effective communication by creating biases and misconceptions. Ethnorelativism is seeing all behavior in a cultural context. Enculturation refers to the process of each person learning his or her culture through socialization with the family or significant group. Ethnicity refers to the group of qualities that mark a person's association with a particular ethnic group (collection of people who have common origins and a shared culture and identity).

Which of the following best exemplifies the attributes of a community health nurse in the researcher role? A) Gaining the trust and respect of the staff members B) Interpreting abstract ideas so others can understand C) Implementing a staff development program for a technique D) Evaluating the correlation between variables in specific health conditions

Answer: Evaluating the correlation between variables in specific health conditions Rationale: Attributes of a researcher include a spirit of inquiry, careful observation, analytic skills, such as evaluating the possible cause and effect of a situation, and tenacity. Gaining the trust and respect of staff, interpreting abstract ideas, and implementing a staff development program are examples of the management skills used in the role of manager.

A community health nurse is involved in education, screening, referral, and support for the individuals of a specific religious congregation. The nurse is practicing in which setting? A) Occupational health nursing B) Faith community nursing C) School nursing D) Residential institution nursing

Answer: Faith community nursing Rationale: In faith community nursing, the practice focal point is the faith community and the religious belief system provided by the philosophical framework. It may be called church-based health promotion, parish nursing, or primary care parish nursing practice. Occupational health nursing occurs in business and industry settings. School nursing, as the name implies, involves practicing in the school system, including from preschools to colleges and universities. Residential institution nursing occurs in any facility where the clients reside such as a halfway house or continuing care center.

After teaching a group of students about the various settings for community health nursing, the instructor determines that this teaching was successful when the students identify which of the following as an example of ambulatory service setting? A) Local preschool B) Halfway house C) Continuing care center D) Family planning clinic

Answer: Family planning clinic Rationale: Ambulatory service setting includes a variety of venues for community health nursing in which clients come for day or evening services that do not include overnight stays. One example is a family planning clinic. A local preschool would be an example of a school setting. A halfway house and continuing care center are examples of residential institutions.

A community health nurse working with a group of families who come to local community health care center tells them that she is going to be setting up child care so that the families can participate in the various classes being offered by the center. Three months have passed, and the nurse still has not instituted the child care program. The nurse has violated which ethical principle?''' A) Veracity B) Fidelity C) Justice D) Respect Ans: B

Answer: Fidelity Feedback: Fidelity means keeping promises or commitments to foster trust and trustworthiness. By failing to set up the child care program, the nurse has violated this fidelity. Nurses who follow through on what they have said earn their clients' respect and trust. In contrast, when a commitment is not kept, community members may lose faith and interest in participation. Veracity refers to telling the truth, giving clients accurate information in a timely manner. Veracity involves treating clients as equals. Justice refers to treating people fairly, such as by ensuring equal access to health care and not limiting the amount or quality of services due to income level. Respect involves acknowledging clients as valued participants in shaping their own and the community's health outcomes.

Community health nursing has a long history of contributing to the health of populations. Which of the following forms of service would the nurse identify as being most recent? A) Voluntary home nursing care for the sick poor via district nursing B) Care provided termed public health nursing C) Lay and religious groups providing care to the sick poor in their homes D) Focus on populations with community health nursing seen as a specialty field

Answer: Focus on populations with community health nursing seen as a specialty field Rationale: The four stages of community health nursing followed from lay and religious groups providing care in the early years before 1850, the more specialized "health nurses" or district nursing after the mid-1800s, concern for the health of the general public from 1900s to 1970, and finally community health nursing as a specialty with a focus on populations since 1970.

A group of nursing students are studying for an examination on influential nursing leaders involved in the advancement of community health nursing. The students demonstrate that they are prepared for the examination when they identify which person as the first community health nurse in the United States? A) Frances Root B) Mary Robinson C) Mary Seacole D) Reba Thelin

Answer: Frances Root Rationale: In the United States, Frances Root was the first community health nurse who was hired by the Women's Branch of the New York Mission in 1877. Mary Robinson was the nurse who cared for William Rathbone's wife and was hired by Rathbone to visit the sick poor in their homes in England. Mary Seacole, the "Black Nightingale," practiced Creole or Afro-Caribbean medicine in Jamaica and helped populations who experienced tropical diseases in Central America, Panama, and the Caribbean. Reba Thelin was a nurse hired by Johns Hopkins Hospital to visit the homes of tuberculosis clients in 1903.

When working in the community, the community health nurse adopts the teaching plan to ensure that the population understands the basic information provided to address which of the following? A) Self-care B) Health disparities C) Health literacy D) Episodic needs

Answer: Health literacy Rationale: Consumers are often intimated by health professionals and are uninformed about health and health care affecting the quality of care. Adopting a teaching plan to ensure that the population understands the basic information addresses health literacy, the ability to read, understand, and use health care information appropriately. Doing so helps to ensure that the teaching plan will be effective. Self-care refers to the process of taking responsibility for developing one's own health potential by actively participating in promoting one's own health. Health disparities reflect differences in all aspects of health care related to vulnerable populations. Episodic needs are one-time specific negative health events that arise and are not an expected part of life.

A group of community health nursing students design a health education program for a group of pregnant teens that includes teaching nutrition during pregnancy, demonstrating helpful exercises, and discussing their concerns. This is an example of which of the following? A) Health promotion B) Treatment of disorders C) Rehabilitation D) Evaluation

Answer: Health promotion Rationale: The student nurses are engaging in health promotion activities. Health promotion incorporates all efforts that seek to move people closer to optimal well-being or to higher levels of wellness. Treatment of disorders would include direct care for issues involving the group, such as complications that might arise in this population. Rehabilitation would involve activities to minimize disability or restore or preserve function. Evaluation would involve an analysis of the effectiveness of these activities.

The population that community health nurses serve in the United States is changing. Because of population shifts, nurses must become sensitive to the cultural differences and language differences among new community members. Which minority group currently represents the largest group? A) African Americans B) Hispanic Americans C) Asian Americans D) American Indians

Answer: Hispanic Americans Rationale: Significant minorities include Hispanic Americans, numbering more than 35 million in 2000 and over 42 million in 2005 and currently representing over 14% of the population; African Americans, numbering over 37 million or approximately 12.8% of the population; Asian Americans, numbering more than 12 million or approximately 4.3% of the population; and American Indians and Alaska Natives, numbering 2.8 million or 1% of the population.

Which one of the following statements made by a student would the nurse educator recognize as evidence that a student understands the health continuum? A) The distinction between health and illness is well demarcated. B) Illness refers to a state of being relatively unhealthy. C) The term health is limited to reflect an individual's state. D) Treatment of acute conditions reflects the current focus of health care.

Answer: Illness refers to a state of being relatively unhealthy. Rationale: Although society typically depicts an absolute line of difference between being either well or ill, health is considered a relative term. Thus, illness is viewed as a state of being relatively unhealthy. Health is typically described as a continuum that involves a range of degrees from optimal health at one end to total disability or death at the other. The line of demarcation is not clear. Health applies to individuals, families, and communities. Traditionally, most health care has focused on the treatment of acute and chronic conditions at the illness end of the continuum, but this emphasis is shifting to focus on the wellness end.

Which one of the following statements about cultivating a spirit of inquiry is most accurate? A) It is not very important; research will be performed anyway. B) In order for effective change to occur, current practices must be continually examined, questioned, and challenged. C) It involves "asking the burning clinical question." D) The agency does not have an important role in cultivating a spirit of inquiry.

Answer: In order for effective change to occur, current practices must be continually examined, questioned, and challenged Rationale: In order for effective change to occur, current practices must be continually examined, questioned, and challenged. It is very important that the spirit of inquiry is cultivated. "Asking the burning clinical question" is part of the next step of asking the question. The agency does have a role in cultivating a spirit of inquiry. The organization must be open to a cultural shift from the status quo. The foundations of this spirit of inquiry are ongoing curiosity and a culture that supports it.

Which of the following statements would best describe the difference between public health nursing and community health nursing? A) Public health nursing is focused on the private aspects of health, and community health nursing is focused on the public aspects of health. B) In our textbook, the term community health practice refers to a focus on specific, designated communities and is a part of the larger public health effort. C) Public health nursing and community health nursing relate to the very same types of services and perspectives. D) Both public health nursing and community health nursing are practiced exclusively within institutions.

Answer: In our textbook, the term community health practice refers to a focus on specific, designated communities and is a part of the larger public health effort. Rationale: In this textbook, community health practice refers to a focus on specific, designated communities. It is a part of the larger public health effort and recognizes the fundamental concepts and principles of public health as its birthright and foundation for practice. Public health nursing is focused on the public aspects of health. Public health nursing and community health nursing have distinctive types of services and perspectives. Neither public health nursing nor community health nursing is practiced exclusively within institutions.

When working with clients, a community health nurse promotes the clients' self-concept and health promoting behaviors. The nurse is attempting to achieve which outcome? A) A value system B) Prescriptive-proscriptive beliefs C) Individual autonomy D) Values clarification

Answer: Individual autonomy Rationale: Promoting clients' self-concept and health-promoting behaviors are associated with the value of self-determination that promotes individual autonomy. Value system, prescriptive-proscriptive beliefs, and values clarification are not associated with self-determination. A value system is an organized set of beliefs that guide individual behavior. Prescriptive-proscriptive beliefs are viewed as desirable or undesirable beliefs. Values clarification is a process that helps identify the personal and professional values that guide actions.

When describing culture as shared, which of the following would be most accurate? A) It is acquired, not inherited. B) It is a product of aggregate behavior. C) It is interrelated and interdependent. D) It undergoes change.

Answer: It is a product of aggregate behavior. Rationale: When describing culture as shared, it means that it is a product of aggregate behavior, not an individual habit. The customs are phenomena shared by all members of the group. Culture is learned; that is, the patterns of cultural behavior are acquired, not inherited. Culture is integrated; that is, it is a functional, integrated whole where all parts are interrelated and interdependent. Culture is dynamic; that is, it is changeable and not entirely static.

After teaching a class on values, which of the following, if stated by the class, indicates the need for additional teaching? A) Some values are descriptive, while others are evaluative. B) Keeping a promise is an example of a terminal value. C) Values persist, remaining relatively stable over time. D) Certain values have more importance than others.

Answer: Keeping a promise is an example of a terminal value. Rationale: Terminal values refer to end states of existence such as spiritual salvation, peace of mind, or world peace. Instrumental values refer to modes of conduct such as confidentiality, keeping promises, and honesty. Some values are descriptive or capable of being true or false, while other values are evaluative, involving judgments of good and bad. Values remain relatively stable over time and persist to provide continuity to personal and social existence. A hierarchical system of values occurs in which certain values have more weight or importance than others.

A student is planning a presentation about the evolution of public health nursing. As part of the presentation, the student would identify which person as being the first one to use the term "public health nursing"? A) Jessie Sleet B) Lillian Wald C) Lina Rogers D) Margaret Sanger

Answer: Lilian Wald Rationale: Lillian Wald, a leading figure in the expansion of district nursing, was the first to use the term "public health nursing" to describe the specialty. Jessie Sleet was credited as being the first Black public health nurse. Lina Rogers was credited with being the first school nurse. Margaret Sanger was the nurse who opened the first birth control clinic in America that eventually resulted in the formation of the International Planned Parenthood Federation.

Of all the nursing roles assumed by community health nurses, which role must be assumed in every situation? A) Researcher B) Manager C) Leader D) Clinician

Answer: Manager Rationale: The type and number of roles that are practiced vary with each set of clients and each specific situation, but the nurse should be able to successfully function in each of these roles as the particular situation demands. The role of manager is one that the nurse must play in every situation, because it involves assessing clients' needs, planning and organizing to meet those needs, directing and leading clients to achieve results, and controlling and evaluating the progress to ensure that the goals and clients' needs are met.

A community health nurse is reviewing his or her schedule for the day. Included in his or her activities are planning client care, leading a staff conference, and supervising a new staff member. This nurse is fulfilling which role? A) Advocate B) Manager C) Collaborator D) Researcher

Answer: Manager Rationale: When functioning in the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals. Overseeing client care as a case manager, supervising ancillary staff, managing caseloads, running clinics, or conducting community health needs assessment projects are examples of activities associated with the manager role. In the advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the collaborator role, the nurse would work with numerous members of the health team, working jointly with others in a common endeavor. In the researcher role, the community health nurse engages in systematic investigation, collection, and analysis of data for solving problems and enhancing community health practice.

Which of the following nurses openly defied a law that she saw as unjust and eventually resulted in the formation of The International Planned Parenthood Federation? A) Lillian Wald B) Florence Nightingale C) Margaret Sanger D) Mary Brewster

Answer: Margaret Sanger Rationale: Margaret Sanger openly defied a law that she saw as unjust (the Comstock Act that prohibited the provision of any information on contraception to women). This defiance eventually resulted in the formation of The International Planned Parenthood Federation. During the same period that Lillian Wald and her contemporaries were working to alleviate the suffering caused by disease and poverty, Margaret Sanger began a different battle. Florence Nightingale wrote a series of papers on the need for "home missioners" and "health visitors" and endorsed the view that prevention was better than cure. Mary Brewster was a nurse and a friend of Lillian Wald who both together started the Henry Street Settlement.

After discussing the leading health indicators with a class, which condition if stated by the class as one of these indicators suggests that the class has understood the information? A) Cardiac disease B) Mental health C) Sedentary lifestyle D) Maternal health care

Answer: Mental health Rationale: Mental health is a leading health indicator. Other leading health indicators include physical activity, overweight and obesity, tobacco use, substance use, responsible sexual behavior, injury and violence, environmental quality, immunization, and access to health care.

After teaching a class on ethical principles, the instructor determines that the class needs additional instruction when they identify which of the following as an ethical principle? A) Respect B) Autonomy C) Morality D) Justice

Answer: Morality Rationale:Morality is the behavior or judgment that conforms to a standard that is right and good. When judgments involve moral values, conflicts are inevitable. There are seven fundamental ethical principles that guide decision making. These include respect, autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.

After a class discussion on moral evaluations, which characteristic if identified by the class would lead the instructor to determine that the discussion has been effective? A) There is specificity that applies to an individual person. B) A special place is given to a person's own welfare. C) Other values cannot override the moral evaluation. D) They relate to a matter of individual taste.

Answer: Other values cannot override the moral evaluation Rationale: Moral evaluations have distinctive characteristics: the evaluations are ultimate, having a preemptive quality, meaning that other values or human ends cannot, as a rule, override them; they possess universality or reflect a standpoint that applies to everyone, such that everyone in principle ought to be able to make and understand, even if some individuals, in fact, do not; moral evaluations avoid giving a special place to a person's own welfare, having a focus that keeps others in view, or at least considers one's own welfare on a par with that of others. Moral evaluations are prescriptive-proscriptive beliefs that have certain characteristics separating them from other evaluations including matters of taste.

A community health nurse is assuming the role of a manager. Which function would be most important for the nurse to address first? A) Planning B) Organizing C) Leading D) Controlling

Answer: Planning Rationale: The management process incorporates a series of problem-solving activities or function: planning, organizing, leading, and controlling and evaluating. Although these activities occur simultaneously, they are sequential with planning being the first activity.

While visiting an Asian American family in their home, the community health nurse inspects the skin of the 3-year-old child and notices a bruise-like lesion on the child's abdomen. The mother states that the child has been experiencing diarrhea for 2 days. Which of the following would the nurse do next? A) Report the family to the local child abuse agency B) Recognize this as a normal skin variation C) Question the family about the use of cupping D) Obtain a blood test for clotting function

Answer: Question the family about the use of cupping Rationale: The nurse needs to gather additional information about the lesion. Practicing transcultural nursing would require the nurse to perform a cultural assessment and question the family about their use of dermabrasive techniques such as cupping that would leave a bruise-like lesion on the skin and be mistaken for physical abuse. The nurse would report the family to the local child abuse agency if further investigation provides additional information to support that decision. The lesion is not a normal skin variation. Obtaining a blood test for clotting function would be warranted only if further assessment reveals additional bruising or other signs of clotting problems.

Which of the following most accurately reflects the response of community health nursing to economic forces? A) Decreased competition with other community health service providers B) Reduction in available programs and services C) Development of new services for generating revenue D) Switch to a more illness-oriented philosophy for service

Answer: Reduction in available programs and services Rationale: Economic forces have led community health nursing to respond by developing new revenue-generating services to augment depleted budgets. Other responses include directly competing with other community health service providers and developing new programs and service emphases. Although some public health agencies have been drawn into more illness-oriented services, community health nursing continues to be resourceful in finding ways to foster the community's optimal health.

A community health nurse working a large metropolitan city has a large Asian American client base. Which of the following would the nurse be least likely to assess in this population? A) Belief that illness results from a body imbalance B) Reliance on Western medical practices C) Use of traditional self-care practices D) A focus on patriarchal family structures

Answer: Reliance on Western medical practices Rationale: Asian Americans believe illness results from an imbalance of yin and yang forces. They use traditional healers and also exercise traditional self-care practices before using Western medical practices.

In their early stages, district nursing was sponsored by which of the following? A) Religious organizations B) Private philanthropy C) Contributions D) Public funding

Answer: Religious organizations Rationale: Early district nursing services were founded by religious organizations that served as their sponsors. Later sponsorship shifted to private philanthropy. Funding came from contributions and fees charged to clients on an ability-to-pay basis. Finally, visiting nursing began to be supported by public money.

Which of the following would be crucial for the community health nurse to address as the priority when dealing with policy makers about the development of community health programs? A) Research-based best practices B) Population's make up C) Amount of services to be provided D) Scarcity of the available resources

Answer: Research-based best practices Rationale: Decisions for programs or services are often made on the basis of cost-effectiveness or cost-benefit. Therefore, community health nurses must provide policy makers with information about best practices, grounded in research. Although population make up, amount of services to be provided, and scarcity of resources are factors that may need to be considered, the community health nurse must demonstrate evidence-based practice.

A community health nurse has collected data for several months on the birth weights of newborns to mothers who smoked throughout their pregnancy. This nurse is acting in which role? A) Collaborator B) Manager C) Researcher D) Clinician

Answer: Researcher Rationale: The nurse is assuming the role of a researcher, that is, engaging in systematic investigation that includes data collection. In the collaborator role, the nurse would work with numerous members of the health team, working jointly with others in a common endeavor. In the manager role, the nurse exercises administrative direction toward the accomplishment of specified goals. In the clinician role, the nurse ensures the provision of health care services to individuals, families, groups, and populations.

A community health nurse is applying the value of equity in decision making with clients. Which of the following best describes this value? A) Forming, revising, and pursuing personal life plans B) Promoting clients' health and a sense of well-being C) Fulfilling one's desires over those of others D) Treating similar cases in the same fair fashion

Answer: Treating similar cases in the same fair fashion Rationale: Equity is defined as the value directing like cases to be treated alike and that all individuals be treated fairly. Self-determination refers to a person's exercise of the capacity to shape and pursue personal plans for life. Well-being involves promoting clients' health and sense of well-being. Self-interest is the fulfillment of one's own desires without regard for the greater good.

When fulfilling the function of assessment, which of the following would be most important for the community health nurse to do? A) Secure the trust of the clients B) Gather appropriate information C) Interact with key community leaders D) Use a variety of assessment tools

Answer: Secure the trust of the clients Rationale: Although securing and maintaining the trust of others is pivotal to all nursing practice, it is even more critical when working in the community. Trust can afford a nurse access to client populations that are difficult to engage, to agencies, and to health care providers. As difficult as it may be for the nurse to gain the trust and respect of the community, if it is ever lost, these attributes can be difficult if not impossible to regain. Gathering information, interacting with key community leaders, and using a variety of assessment tools are important, but they can only occur after trust is established.

After a class that described the differences between acute care nursing and community health nursing, which statement by the class about community health nurses indicates successful teaching? A) Use a reactive approach. B) Seek out potential health problems. C) Concentrate on the illness end of the continuum. D) Emphasize curative care.

Answer: Seek out potential health problems Rationale: Community health nurses, in contrast to acute care nurses, seek out potential health problems, identifying high-risk groups and instituting preventive programs; use a proactive approach; concentrate on the wellness end of the health continuum; and put less emphasis on curative care.

A community health nurse obtains a client's informed consent for care demonstrating the understanding that this is derived from which value? A) Self-interest B) Well-being C) Equity D) Self-determination

Answer: Self-determination Rationale: Informed consent derives from self-determination. Self-interest refers to a deterioration of self-determination in which the person focuses on fulfilling one's own desires without regard for the greater good. Well-being is a state of positive health, the intent of all therapeutic interventions. Equity refers to justice or fair and equal treatment.

A group of students are reviewing for an examination on values. Identification of which of the following as an instrumental value indicates the need for continued study? A) Spiritual salvation B) Confidentiality C) Honesty D) Promise keeping

Answer: Spiritual salvation Rationale: Spiritual salvation is an example of a terminal value, which refers to end states of existence. An instrumental value refers to a mode of conduct, such as confidentiality, promise keeping, and honesty.

Which of the following statements about the importance of the role of collaborator is true? A) Community health nurses frequently practice in isolation. B) Successful community health practice depends on multidisciplinary collegiality and leadership. C) Community health nurses must assert themselves as the most powerful person on the health care team to ensure each client receives services that are necessary. D) It is best for community health nurses to focus on what they, as nurses, can do for their clients.

Answer: Successful community health practice depends on multidisciplinary collegiality and leadership Rationale: Community health nurses seldom practice in isolation. As collaborators, nurses work jointly with others in a common endeavor, cooperating as partners. Successful community health practice depends on multidisciplinary collegiality and leadership. The community health nurse's collaborator role requires skills in communicating, in interpreting the nurse's unique contribution to the team, and in acting assertively as an equal partner.

Which factor was the most significant feature associated with district nursing? A) Caring for the sick B) Teaching hygiene and cleanliness C) Preventing illness D) Gathering statistical data

Answer: Teaching hygiene and cleanliness Rationale: Although district nurses primarily cared for the sick, they also taught cleanliness and wholesome living to their clients. This early emphasis on prevention and health became one of the distinguishing features of district nursing and later of public health nursing. Preventing illness and gathering statistical data were key contributions of Florence Nightingale during the Crimean War of the early 1850s.

Which of the following differentiates the home setting for community health nursing from other settings? A) The nurse acts primarily as an educator. B) The client is viewed within his or her environment. C) Technologically advanced care is limited. D) The home is being used less frequently today.

Answer: The client is viewed within his or her environment Rationale: In the home, unlike most other health care settings, clients are on their own "turf," such that the client is the host, comfortable and secure in familiar surroundings, and the nurse is a guest. Although education may be a major component of care in the home, all community health nursing roles are performed to varying degrees. In addition, technologically advanced care in the home is increasing in demand, with the home being the most frequently used setting for community health nursing.

Which of the following statements about the role of educator within the framework of public health nursing functions is true? A) The educator role has the potential for finding greater receptivity and providing higher-yield results. B) People are unable to recognize the value of health and are not well motivated to achieve higher levels of wellness. C) It is only possible for a nurse to reach a limited number of persons. D) The public's higher level of health consciousness hinders the educator's role.

Answer: The educator role has the potential for finding greater receptivity and providing higher-yield results Rationale: The educator role has the potential for finding greater receptivity and providing higher-yield results. People are recognizing the value of health and are increasingly motivated to achieve higher levels of wellness. With an emphasis on populations and aggregates, the educational efforts of community health nursing are appropriately targeted to reach many people. One factor that enhances the educator role is the public's higher level of health consciousness.

A community health nurse works to ensure the greatest good for the greatest number of people by applying which of the following? A) Secondary prevention activities B) Autonomy C) Justice D) Utilitarianism

Answer: Utilitarianism Rationale: The ethical theory of utilitarianism promotes the greatest good for the greatest number. Primary prevention activities, not secondary prevention, are the priority. Autonomy refers to the freedom of choice. Justice involves treating people fairly.

Which of the following statements about the steps of the EBP process is most accurate? A) One of the last steps of the EPB process is to search for and collect the most relevant best evidence. B) One of the earliest steps in the EBP process is to disseminate the outcomes of the EBP decision or change. C) It is optional to integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change. D) The first step in the EBP process is to cultivate a spirit of inquiry.

Answer: The first step in the EBP process is to cultivate a spirit of inquiry. Rationale: The steps of the EBP process in order are cultivating a spirit of inquiry; asking the burning question in PICOT format; searching for and collecting the most relevant best evidence; critically appraising the evidence for its validity, reliability, and applicability and then synthesizing that evidence; integrating the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change; evaluating outcomes of the practice decision or change based on evidence; and disseminating the outcomes of the EBP decision or change.

Which of the following statements about the community health nurse's selection and practice of each role is true? A) Within a given time, a community health nurse may practice multiple roles. B) The knowledge that vulnerable populations need someone to guide them through the complexities of the health care system and the nurse can serve as an advocate for them C) The researcher role for community health nurses involves only the use of quantitative statistics. D) The leadership role consists solely of managing staff.

Answer: The knowledge that vulnerable populations need someone to guide them through the complexities of the health care system and the nurse can serve as an advocate for them Rationale: Community health nurses wear many hats while conducting day-to-day practice. At any given time, however, one role is primary. They need someone to guide them through the complexities of the system and assure the satisfaction of their needs. This is particularly true for minorities and disadvantaged groups. Although research technically involves a complex set of activities conducted by persons with highly developed and specialized skills, research also means applying that technical study to real-practice situations. As leaders, community health nurses seek to initiate changes that positively affect people's health.

What is the most serious negative effect of a nurse maintaining ethnocentric views but not recognizing or acknowledging this? A) The nurse fails to understand the views of other cultures because of his or her ethnocentrism. B) The nurse does not communicate effectively with members of other cultures because of his or her ethnocentrism. C) The nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. D) Nurses are immune to the effects of ethnocentrism.

Answer: The nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. Rationale: The most negative effect of nurses maintaining ethnocentric views but not recognizing or acknowledging this is that the nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. The nurse who is ethnocentric and doesn't realize it will fail to understand the views of other cultures, but this is not the most serious negative effect. If the nurse is ethnocentric, he or she may not communicate effectively because of his or her ethnocentrism, and this can lead to impaired relationships and interference with the effectiveness of nursing interventions. All nurses hold ethnocentric views, but it is important for the nurse to be aware of them and acknowledge them to avoid having it damage relationships and interfere with the effectiveness of nursing interventions.

Which of the following is included in the most accurate description of school nursing? A) This is one community health setting where the role is static. B) The primary role of school nurses is clinician. C) The practice of school nurses is widening. D) School nurses rarely act as advocates.

Answer: The practice of school nurses is widening Rationale: School nurses, whose primary role initially was that of clinician, are widening their practice to include more health education, interprofessional collaboration, and client advocacy.

A group of students are reviewing the various historical events associated with the evolution of community health nursing in preparation for a test. They identify the time from 1970 to the present as the era known as community health nursing based on the understanding that which of the following influences contributed most to this change? A) The settings and the nurses delivering healthcare in the community B) Decisions made by the American Nurses Association C) Decisions made by physicians in a variety of community settings D) The demand to eliminate the word "public" from health services

Answer: The settings and the nurses delivering healthcare in the community Feedback: The numbers, increasing variety of settings, and many nurses coming to work in the community settings since the 1970s have contributed most significantly to the change. As a result, professional associations supported the broader term of community health nursing. Physician decisions played no role in the change. The term public health nursing still remains.

After teaching a group of students about the changing roles of the community health nurse in the occupational setting, the instructor determines that the students need additional teaching when they state which of the following? A) Occupational health nurses are increasing their role as employee advocates. B) Health education is a key function of the occupational health nurse. C) There is a greater emphasis on the occupational health nurse's role as a clinician. D) Collaboration with other health care providers fosters the offering of better services.

Answer: There is a greater emphasis on the occupational health nurse's role as a clinician. Rationale: The clinician role was primary for many years, as nurses continued to care for sick or injured employees at work. However, recognition of the need to protect employees' safety and, later, to prevent their illness led to the inclusion of health education in the occupational health nurse role. Occupational health nurses also act as employee advocates, assuring appropriate job assignments for workers and adequate treatment for job-related illness or injury. They collaborate with other health care providers and company management to offer better services to their clients. They act as leaders and managers in developing new health services in the work setting, endorsing programs such as hypertension screening and weight control.

Which of the following statements about evidence-based practice has been identified by multiple reports over the past decade, such as To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003)? A) We must continue to cling to "the way we've always done it." B) We have spent billions of dollars each year researching new treatments and have translated that knowledge into clinical practice. C) We are not translating the knowledge that we are gaining into clinical practice. D) We have continued to spend more than a trillion dollars a year providing care and do translate that capacity into improved clinical practice.

Answer: We are not translating the knowledge that we are gaining into clinical practice Rationale: To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003). These reports draw attention to the fact that we spend billions of dollars each year researching new treatments, and more than a trillion dollars are spent annually on health care, but "we repeatedly fail to translate that knowledge and capacity into clinical practice."

When discussing the concept of the health continuum with a class, the nurse educator would be certain to include which statement in the description? A) Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. B) A client's placement on the health continuum is static throughout time. C) Health is best described as cyclic. D) The health continuum can only be applied to individuals.

Answer: Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. Rationale: Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. The continuum can change. Because health involves a range of degrees from optimal health at one end to total disability or death at the other, it is often described as a continuum. The health continuum applies not only to individuals but also to families and communities.

A community health nurse is preparing a presentation for a group of nursing students about community health nursing. Which of the following descriptions about community health nursing would the nurse most likely include in the presentation? A) Focusing on addressing continuous needs B) Working with the client as an equal partner C) Engaging in tertiary prevention as the priority D) Encouraging clients to reach out to the nurse

Answer: Working with the client as an equal partner Rationale: The community health nurse works with the client as an equal partner, encouraging autonomy. At any time, the nurse deals with continuous and episodic needs simultaneously. Primary prevention is the priority for community health nurses. The community health nurse engages in primary prevention as the priority, having the obligation to actively reach out to all who might benefit from a specific activity or service.

Situations in which self-determination should be restricted include which of the following? Select all that apply. A) When some objectives of individuals are contrary to the public interest or the interests of others in society B) When a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals C) When it interferes with self-interest D) Self-determination and personal autonomy must never be restricted. E) When self-determination deteriorates into self-interest and poses a major roadblock to equitable care

Answers -When some objectives of individuals are contrary to the public interest or the interests of others in society -When a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals Rationale: There are two situations in which self-determination should be restricted: when some objectives of individuals are contrary to the public interest or the interests of others in society (e.g., endangering others with a communicable disease) and when a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals. When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care.

According to the Institute of Medicine's landmark report, The Future of Nursing, nurses should: Select all that apply. A) work independently from other health professionals to promote the profession of nursing. B) work collaboratively with other health professionals to promote health care. C) attempt to redesign health care. D) improve practices through evidence-based means. E) The Future of Nursing report does not express the importance of evidence-based nursing.

Answers -work collaboratively with other health professionals to promote health care. -attempt to redesign health care. -improve practices through evidence-based means.

Which of the following are core values of professional behavior that are unique to public health nursing? Select all that apply. A) Community/population as client B) Prevention C) Rehabilitation D) Partnership E) Healthy environment F) Diversity

Answers -Community/population as client -Prevention -Partnership -Health environment -Diversity Rationale: Core values of professional behavior emphasize community/population as client, prevention, partnership, healthy environment, and diversity. Rehabilitation is not population-centered.

A community health nurse is working with several Native American groups in Arizona. Which of the following would the nurse be most likely to assess? Select all that apply. A) The value of competition B) Respect for advancing age and elders C) Focus of living in the future D) Frequent dialogue and discussion E) Each tribe or nation has its own distinct language, beliefs, customs, and rituals.

Answers -Respect for advancing age and elders -Focus of living in the future -Each tribe or nation has its own distinct language, beliefs, customs, and rituals. Rationale: Although there are differences among Native American tribes, most have respect for advancing age and they live in the present and not the distant future (making primary prevention activities more difficult). Each tribe or nation has its own distinct language, beliefs, customs, and rituals. Competition and frequent dialogue and discussion are not values held by Native Americans.

A community health nurse works in a busy community health nursing practice. Today, the nurse is devoting the day to the educator role. With which of the following activities would the nurse be involved? Select all that apply. A) Planning seven home visits today B) Working on a new curriculum for high-risk teens C) Meeting with colleagues to discuss organizational changes in the office D) Ordering pamphlets over the Internet to be used in a parenting class E) Tabulating data from surveys distributed to elders during a flu-shot clinic F) Going to social services to speak up for a family in his or her caseload

Answers: -Working on a new curriculum for high-risk teens -Ordering pamphlets over the Internet to be used in a parenting class Rationale: In the educator role, the nurse would work on a new curriculum for high-risk teens and order pamphlets for use in a parenting class. Planning seven home visits would be part of the clinician role. Meeting with colleagues to discuss organizational changes would be part of the manager role. Tabulating data from surveys would be part of the researcher role. Speaking up for a family in the nurse's caseload would be an example of the advocate role.

A nursing student is interviewing a community health nurse about the various roles the nurse assumes and the skills and behaviors necessary to perform each role. Which of the following would the community health nurse identify as being essential to the role of an advocate? Select all that apply. A) Assertiveness B) Ability to plan C) Ability to negotiate D) Risk-taking E) Holistic view F) Questioning attitude

Answers: -Assertiveness -Ability to negotiate -Risk taking Rationale: As an advocate, the community health nurse must be assertive, willing to take risks, be able to communicate and negotiate well, and be able to identify resources and obtain results. The ability to plan is associated with the manager role. A holistic view is critical to the community health nurse acting as a clinician. A questioning attitude is necessary for the role as a researcher.

A community health nurse is devoting the day to being a manager. Which activities would the nurse expect to perform? Which of the following activities are part of this role? Select all that apply. A) Orienting three new community health nurses in the agency B) Attending a strategy meeting for a new service the community will be offering C) Working with a team to direct a smoking cessation program in public areas D) Investigating an outbreak of Salmonella in the community E) Tabulating the findings of exploring immunization practices among teens F) Reviewing the staff evaluations to assist with planning future in-services

Answers: -Orienting three new community health nurses in the agency -Attending a strategy meeting for a new service the community will be offering -Reviewing the staff evaluations to assist with planning future in-services Rationale: As a manager, a community health nurse would be involved in orienting new nurses in the agency, attending meetings for new services to be offered, and reviewing staff evaluations. Working with a team to direct a smoking cessation program in public areas exemplifies the leadership role. Investigating an outbreak of Salmonella and tabulating the findings of immunization practices depict the researcher role.

The community health nurse is developing a plan of primary prevention activities. Which of the following might the nurse include? Select all that apply. A) Teaching about safe-sex practices to high school students B) Encouraging older adults to install safety devices in the bathroom C) Providing regular immunization programs for communicable diseases D) Participating in cholesterol screening programs at health fairs E) Providing skin testing for tuberculosis for children over 1 year of age F) Working with a group testing water samples for contamination

Answers: -Teaching about safe-sex practices to high school students -Encouraging older adults to install safety devices in the bathroom -Providing regular immunization programs for communicable diseases Rationale: Primary prevention activities are those taken to keep illness or injuries from occurring. These include teaching about safe-sex practices, encouraging older adults to use safety devices in the bathroom, and providing regular immunization programs for communicable diseases. Cholesterol screening programs, skin tests for tuberculosis, and working with a group testing water samples for contamination are examples of secondary prevention activities.

Which of the following activities would be associated with a community health nurse? Select all that apply. A) Examining infants in a city well-baby clinic B) Caring for elderly stroke victims in their homes C) Providing emergency care in an acute care facility D) Carrying out epidemiologic research E) Participating in health policy analysis

Answers: A. Examining infants in a city well-baby clinic B. Caring for elderly stroke victims in their homes D. Carrying out epidemiologic research E. Participating in health policy analysis Rationale: Community health nurses work in every conceivable kind of community agency, from a state public health department to a community-based advocacy group. Their duties range from examining infants in a well-baby clinic or teaching elderly stroke victims in their homes to carrying out epidemiologic research or engaging in health policy analysis and decision making. Providing care in an acute care facility would not be an activity associated with a community health nurse.

Which of the following actions by the community health nurse exemplifies the societal influence of causality on the practice of community health nursing? A) Using computer-based education programs for client education B) Engaging in video conferencing to share research findings C) Identifying multiple factors associated with promoting wellness D) Developing a plan to address the rapid increase in older adult population

Identifying multiple factors associated with promoting wellness Rationale: Causal thinking relates disease or illness to its cause and includes areas such as epidemiology; interactions among an agent, host, and environment; and recognition of multiple factors contributing to a disease, health disorder, or wellness. Using computer-based education programs and engaging in video conferencing are examples reflecting the advancement of technology. Developing a plan to address the rapid increase in the older adult population involves application of the change in demographics affecting community health nursing.

Which of the following research studies would most likely use a quantitative research approach? A) The relationship of maternal age and history of parents' vaccine-preventable disease and parents' efforts to have their children immunized B) The experience of parents whose children have had serious complications subsequent to immunization C) The experience of parents whose children were not properly immunized and developed a vaccine-preventable illness D) Reasons that parents who practice a particular religion do not have their children properly immunized

The relationship of maternal age and history of parents' vaccine-preventable disease and parents' efforts to have their children immunized Rationale: Quantitative research is helpful in identifying a problem or a relationship between two or more variables, such as type of treatment. A more subjective or qualitative approach is needed to study those areas that need a broader focus or that do not lend themselves to objective measurement. Qualitative research emphasizing subjectivity asks "how" or "why."